[Recommendations for the care of patients with community-acquired pneumonia in the Emergency Department]. / Recomendaciones para la atención del paciente con neumonía adquirida en la comunidad en los Servicios de Urgencias.

The incidence of community-acquired pneumonia (CAP) ranges from 2-15 cases / 1,000 inhabitants / year, being higher in those older than 65 years and in patients with high co-morbidity. Around 75% of all CAP diagnosed are treated in the Emergency Department (ED). The CAP represents the main cause for sepsis and septic shock in ED, and the most frequent cause of death and admission to the Intensive Care Unit (ICU) due to infectious disease. Overall mortality is 10-14% according to age and associated risk factors. Forty to 60% of CAP will require hospital admission, including observation units (with very variable ranges from 22-65% according to centers, seasonal of the year and patients´ characteristics). Between the admissions, 2-10% will be in the ICU. All of previously mentioned reflects the importance of the CAP in the ED, as well as the "impact of the emergency care on the patient with CAP", as it is the establishment where the initial, but key decisions, are made and could condition the outcome of the illness. It is known the great variability among physicians in the diagnostic and therapeutic management of CAP, which is one of the reasons that explains the great differences in the admission rates, achievement of the microbiological diagnosis, request for complementary studies, the choice of antimicrobial treatment, or the diversity of applied care. In this sense, the implementation of clinical practice guidelines with the use of the severity scores and the new tools available, such as biomarkers, can improve patient care with CAP in ED. Therefore, a multidisciplinary group of emergency professionals and specialists involved in the care process of CAP has designed a guideline with several recommendations for decisions-making during the key moments in patients with CAP attended in the ED.

[Pharyngitis due to Burkholderia cepacia. Person-to-person transmission]. / Faringitis por Burkholderia cepacia. Transmisión de persona a persona.

Burkholderia cepacia is a Gram-negative bacillus that is widely distributed in nature; it is isolated from the ground, water, plants and vegetables. Generally, it produces nosocomial infection due to contamination of disinfectants, medical equipment, prosthetic material and drugs, such as anesthetics or liquids used in urological irrigation. The most probable mechanism of transmission is through hospital material or through fomites among people after contact for several weeks or months. Recently, it has been considered as an important pathogen in immunocompromised patients, or in those with significant underlying diseases, such as chronic granulomastosis or cystic fibrosis. We present a case of pharyngitis due to B. cepacia and its transmission within a few days in two immunocompetent twin siblings without previous underlying diseases. The infection disappeared after specific treatment for this microorganism was started. We believe that samples should be taken from the pharynx and nasal pits in patients with acute upper respiratory tract processes that do not respond to empiric antibiotic treatment, before classifying them as viral infection without etiologic diagnosis.

Faringitis por Burkholderia cepacia. Transmisión de persona a persona / Pharyngitis due to Burkholderia cepacia. Person-to-person transmission

Burkholderia cepacia es un bacilo gramnegativo que se encuentra ampliamente distribuido en la naturaleza, y se aísla del suelo, el agua y las plantas y verduras. Generalmente produce infección nosocomial por contaminación de desinfectantes, equipos médicos, material protésico y fármacos, como anestésicos o líquidos de irrigación urológicos. El mecanismo de transmisión más probable es a través del material hospitalarios o de fomites entre personas tras un contacto de varias semanas o meses. Recientemente, se ha considerado como un patógeno importante en pacientes inmunodeprimidos o con enfermedades de base importantes, como la granulomatosis crónica y la fibrosis quística. Se presenta el caso de una faringitis por B. cepacia y su transmisión en pocos días en dos hermanos gemelos, inmunocompetentes y sin enfermedades de base previas y, la desaparición de la enfermedad tras la instauración de un tratamiento específico para este microorganismo. Consideramos que se deben tomar muestras de faringe y fosas nasales ante un proceso agudo del tracto respiratorio superior que no responde al tratamiento antibiótico empírico, antes de clasificarlo como viriasis sin diagnóstico etiológico (AU)