ABSTRACT
No disponible
Subject(s)
Humans , Medical Overuse/trends , Coronavirus Infections , Pneumonia, Viral , Betacoronavirus , Pandemics , SpainABSTRACT
A pesar de que es conocido que la presencia crónica de microorganismos en las vías aéreas de pacientes con enfermedad pulmonar obstructiva crónica (EPOC) en fase de estabilidad conlleva una evolución desfavorable, ninguna guía de manejo de la enfermedad establece pautas sobre cómo diagnosticar y tratar este tipo de casos. Con la intención de orientar a los profesionales, desde la Sociedad Española de Neumología y Cirugía Torácica (SEPAR) se ha elaborado un documento que pretende aportar respuestas clínicas sobre el manejo de pacientes con EPOC en los que se aíslan microorganismos de forma puntual o persistente. Dado que la heterogeneidad de las evidencias científicas disponibles no permite crear una Guía de Práctica Clínica, se ha elaborado un documento basado en la literatura científica existente y/o en la propia experiencia clínica que aborda tanto la definición de las diferentes situaciones clínicas como su diagnóstico y manejo. El texto ha sido consensuado entre un amplio número de neumólogos con gran experiencia clínica y científica en este ámbito. Este documento cuenta con el aval del Comité Científico de SEPAR
Although the chronic presence of microorganisms in the airways of patients with stable chronic obstructive pulmonary disease (COPD) confers a poor outcome, no recommendations have been established in disease management guidelines on how to diagnose and treat these cases. In order to guide professionals, the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) has prepared a document which aims to answer questions on the clinical management of COPD patients in whom microorganisms are occasionally or habitually isolated. Since the available scientific evidence is too heterogeneous to use in the creation of a clinical practice guideline, we have drawn up a document based on existing scientific literature and clinical experience, addressing the definition of different clinical situations and their diagnosis and management. The text was drawn up by consensus and approved by a large group of respiratory medicine experts with extensive clinical and scientific experience in the field, and has been endorsed by the SEPAR Scientific Committee
Subject(s)
Humans , Bronchitis, Chronic/diagnosis , Bronchitis, Chronic/therapy , Pulmonary Disease, Chronic Obstructive/diagnosis , Pulmonary Disease, Chronic Obstructive/therapy , Societies, Medical/standards , Bronchitis, Chronic/microbiology , Pulmonary Disease, Chronic Obstructive/microbiology , Gram-Negative Bacterial Infections/microbiology , Pneumococcal Infections/diagnosis , Sputum/microbiology , Anti-Bacterial Agents/pharmacology , Administration, Inhalation , Macrolides/therapeutic use , Adrenal Cortex Hormones/therapeutic useABSTRACT
Although the chronic presence of microorganisms in the airways of patients with stable chronic obstructive pulmonary disease (COPD) confers a poor outcome, no recommendations have been established in disease management guidelines on how to diagnose and treat these cases. In order to guide professionals, the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) has prepared a document which aims to answer questions on the clinical management of COPD patients in whom microorganisms are occasionally or habitually isolated. Since the available scientific evidence is too heterogeneous to use in the creation of a clinical practice guideline, we have drawn up a document based on existing scientific literature and clinical experience, addressing the definition of different clinical situations and their diagnosis and management. The text was drawn up by consensus and approved by a large group of respiratory medicine experts with extensive clinical and scientific experience in the field, and has been endorsed by the SEPAR Scientific Committee.
Subject(s)
Bronchitis, Chronic , Pulmonary Disease, Chronic Obstructive , Pulmonary Medicine , Consensus , Humans , Pulmonary Disease, Chronic Obstructive/diagnosisABSTRACT
No disponible
Subject(s)
Humans , Ampicillin/administration & dosage , Cystic Fibrosis/drug therapy , Pneumonia, Staphylococcal/drug therapy , Administration, Inhalation , Staphylococcus aureus/pathogenicity , Retrospective StudiesSubject(s)
Ampicillin/therapeutic use , Anti-Bacterial Agents/therapeutic use , Cystic Fibrosis/complications , Methicillin-Resistant Staphylococcus aureus/drug effects , Pneumonia, Staphylococcal/drug therapy , Administration, Inhalation , Adolescent , Adult , Ampicillin/administration & dosage , Anti-Bacterial Agents/administration & dosage , Child , Child, Preschool , Chronic Disease , Disease Susceptibility , Drug Evaluation , Female , Follow-Up Studies , Haemophilus Infections/complications , Haemophilus parainfluenzae/isolation & purification , Hospitalization/statistics & numerical data , Humans , Male , Methicillin-Resistant Staphylococcus aureus/isolation & purification , Nebulizers and Vaporizers , Pneumonia, Bacterial/complications , Pneumonia, Staphylococcal/etiology , Pneumonia, Staphylococcal/microbiology , Retrospective Studies , Superinfection/microbiology , Young AdultABSTRACT
El tratamiento antifúngico del paciente hematológico ha alcanzado una gran complejidad con la llegada de nuevos antifúngicos y pruebas diagnósticas que han dado lugar a diferentes estrategias terapéuticas. La utilización del tratamiento más adecuado en cada caso es fundamental en infecciones con tanta mortalidad. La disponibilidad de recomendaciones como éstas, realizadas con la mejor evidencia por un amplio panel de 48 expertos, en las que se intenta responder a cuándo está indicado tratar y con qué hacerlo considerando diferentes aspectos del paciente (riesgo de infección fúngica, manifestaciones clínicas, galactomanano, TC de tórax y profilaxis realizada), puede ayudar a los clínicos a mejorar los resultados(AU)
Antifungal treatment in the hematological patient has reached a high complexity with the advent of new antifungals and diagnostic tests, which have resulted in different therapeutic strategies. The use of the most appropriate treatment in each case is essential in infections with such a high mortality. The availability of recommendations as those here reported based on the best evidence and developed by a large panel of 48 specialists aimed to answer when is indicated to treat and which agents should be used, considering different aspects of the patient (risk of fungal infection, clinical manifestations, galactomanann test, chest CT scan and previous prophylaxis) may help clinicians to improve the results(AU)
Subject(s)
Humans , Male , Female , Antifungal Agents/metabolism , Antifungal Agents/pharmacology , Antifungal Agents/therapeutic use , Risk Factors , Drug Resistance, Fungal , Drug Resistance, Fungal/physiology , Drug Resistance, Multiple, Fungal , /methodsABSTRACT
Progressive lung disease, caused by chronic endobronchial colonization, is the major cause of morbidity and mortality in patients with cystic fibrosis (CF). Several pathogens, including Staphylococcus aureus and Pseudomonas aeruginosa are responsible for this effect. The steadily improving prognosis of CF has been attributed to the use of antibiotics with activity against these organisms. Despite a significant increase in the amount of published material demonstrating the potential role of macrolide antibiotics as antiinflammatory agents and their effects on bacterial virulence, their mechanism of action in CF patients is still unknown. Although there is a limited number of clinical trials assessing the efficacy and safety of azithromycin (AZM) in CF, increasing evidence suggests that 3 to 6-month AZM treatment in CF patients is safe and well tolerated. This treatment results in clinical improvement, decreasing the number of pulmonary exacerbations and increasing pulmonary function. Therefore, chronic treatment with AZM should be considered in CF patients added to conventional therapy. Clinical experience with macrolides other than AZM in CF patients is very limited.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Azithromycin/therapeutic use , Cystic Fibrosis/drug therapy , Pneumonia, Bacterial/prevention & control , Clinical Trials as Topic , Cystic Fibrosis/microbiology , HumansABSTRACT
El deterioro pulmonar causado por una colonización endobronquial crónica es la causa principal de morbimortalidad en los pacientes con fibrosis quística (FQ). Varios microorganismos, incluyendo Staphylococcus aureus y Pseudomonas aeruginosa, son origen de este hecho.El aumento de la supervivencia de los pacientes con FQ se ha atribuido sobre todo a la utilización de antibióticos activos frente a estos patógenos.A pesar de que cada vez hay un mayor número de publicaciones que demuestran el papel potencial de los macrólidos como agentes antiinflamatorios y sus efectos en los factores de virulencia bacterianos, su mecanismo de acción en los pacientes con FQ sigue siendo desconocido. Aunque hay pocos estudios que evalúen con rigor la eficacia y seguridad de la azitromicina en los pacientes con FQ, la evidencia disponible sugiere que el tratamiento de 3 a 6 meses de duración con azitromicina en los pacientes con FQ es seguro y bien tolerado. Además produce una mejoría clínica significativa, al reducir las exacerbaciones pulmonares y mejorar la función pulmonar, por lo que debe considerarse como una buena opción terapéutica en estos pacientes que puede añadirse su tratamiento habitual. La experiencia clínica con otros macrólidos diferentes de la azitromicina es muy escasa en los pacientes con FQ (AU)
Subject(s)
Humans , Azithromycin , Pneumonia, Bacterial , Anti-Bacterial Agents , Cystic FibrosisABSTRACT
Clinical categorisation of susceptibility testing results according to criteria established by different committees is daily performed in clinical microbiology laboratories. By this process clinicians can predict the therapeutic success of antimicrobial treatment in patients infected with susceptible microorganisms. In addition, microbiology laboratories that include a suitable number of antimicrobial agents in susceptibility tests can perform interpretive reading of the antibiogram. With this approach, resistance phenotypes are recognized and allow microbiologist: a) detection of mechanisms of resistance, including low levels of expression; b) modification of clinical classifications that are inconsistent with the inferred resistance mechanism; and c) inference of susceptibility values for antimicrobials that are not included in the antibiogram. In the laboratory, this approach facilitates quality control and validation of susceptibility results. Moreover, it increases the value of the results obtained because new mechanisms of resistance can be characterized and the epidemiology of resistance can be established. From the clinical point of view, this approach contributes to improving the adequacy of treatment (since it is useful for predicting therapeutic failure with the use of antimicrobials in patients with infections due to resistant microorganisms) and to controlling and defining antimicrobial policies. Despite the growing complexity of resistance mechanisms, which makes interpretative reading of the antibiogram difficult, this process should be incorporated into routine practice in microbiology laboratories. Interpretive reading of antibiograms is clinically necessary and not simply a intellectual exercise.
Subject(s)
Medical Laboratory Personnel/psychology , Microbial Sensitivity Tests , Algorithms , Anti-Bacterial Agents/classification , Anti-Bacterial Agents/pharmacology , Automation , Bacteria/classification , Bacteria/drug effects , Bacterial Infections/drug therapy , Bacterial Infections/epidemiology , Bacterial Infections/microbiology , Decision Making , Dose-Response Relationship, Drug , Drug Resistance, Bacterial , Drug Resistance, Multiple, Bacterial , Forecasting , Humans , Judgment , Knowledge , Microbial Sensitivity Tests/methods , Microbial Sensitivity Tests/standards , Microbial Sensitivity Tests/trends , Phenotype , Reference Standards , Sensitivity and SpecificityABSTRACT
La categorización clínica de los resultados de sensibilidad en función de los valores establecidos por diferentes comités se realiza diariamente en los laboratorios de microbiología clínica. Este proceso permite la predicción del éxito terapéutico con la utilización de antimicrobianos en pacientes infectados con microorganismos sensibles. Además, los laboratorios que incluyen un número razonable de antimicrobianos en el antibiograma pueden realizar la lectura interpretada de éste. Este proceso consiste en el reconocimiento de los fenotipos de resistencia y permite al microbiólogo: a) la detección de los mecanismos de resistencia, incluyendo los de bajo nivel de expresión; b) la modificación de la interpretación o categorización clínica que es incongruente con el mecanismo de resistencia deducido, y c) la deducción de valores de sensibilidad de antimicrobianos no incluidos en el antibiograma. Desde el punto de vista microbiológico, esta actitud facilita el control de calidad y la validación de los resultados de sensibilidad y aumenta el valor de los resultados ya que facilita la caracterización de nuevos mecanismos y el establecimiento de la epidemiología de la resistencia. Asimismo, contribuye a la mejor adecuación de los tratamientos, ya que es útil para predecir el fracaso terapéutico derivado de la utilización de antimicrobianos en pacientes con infecciones producidas por microorganismos resistentes y también para la definición y el control de las políticas de antimicrobianos. A pesar de la complejidad creciente de los mecanismos de resistencia, este proceso debe incorporarse a la rutina de los laboratorios de microbiología. La lectura interpretada del antibiograma es clínicamente necesaria y no un mero divertimento intelectual (AU)
