Linezolid plus rifampin as a salvage therapy in prosthetic joint infections treated without removing the implant.

The aim of this study is to describe our experience with linezolid plus rifampin as a salvage therapy in prosthetic joint infections (PJIs) when other antibiotic regimens failed or were not tolerated. A total of 161 patients with a documented prosthetic joint infection were diagnosed with a PJI and prospectively followed up from January 2000 to April 2007. Clinical characteristics, inflammatory markers, microbiological and radiological data, and antibiotic treatment were recorded. After a 2-year follow-up, patients were classified as cured when the prosthesis was not removed, symptoms of infection disappeared, and inflammatory parameters were within the normal range. Any other outcome was considered a failure. The mean age of the entire cohort (n = 161) was 67 years. Ninety-five episodes were on a knee prosthesis (59%), and 66 were on a hip prosthesis (41%). A total of 49 patients received linezolid plus rifampin: 45 due to failure of the previous antibiotic regimen and 4 due to an adverse event associated with the prior antibiotics. In no case was the implant removed. The mean (standard deviation) duration of treatment was 80.2 (29.7) days. The success rate after 24 months of follow-up was 69.4% (34/49 patients). Three patients developed thrombocytopenia and 3 developed anemia; however, it was not necessary to stop linezolid. Linezolid plus rifampin is an alternative salvage therapy when the implant is not removed.

[Methicillin susceptible Staphylococcus aureus bacteremia: epidemiology and prognostic factors. A prospective study 2000-2003]. / Bacteriemias por Staphylococcus aureus sensible a meticilina: epidemiología y factores pronósticos. Estudio prospectivo 2000-2003.

BACKGROUND: Staphylococcus aureus bacteremia continues to be a major problem in hospitals due to its high prevalence, severity and treatment difficulties. This study aimed to evaluate epidemiological and clinical features, risk factors and influence of antibiotic choice in outcome and mortality in patients with methicillin susceptible S. aureus bacteremia (SAMSB). PATIENTS AND METHODS: A prospective, observational study of inpatients with SAMSB (2000-3). RESULTS: A total of 131 with SAMSB were included (mean age 56 years; 58% > or = 60 year-old); 56.5% were due to nosocomial bacteremia; 46% of all patients had an underlying condition (diabetes mellitus being the most frequent [28%]); a risk factor for bacteraemia was identified in 98% (intravenous catheter: 72%). Mortality rate was 16% (21/131). Comparative analysis according to nosocomial or community acquisition showed that the former was more frequent in Surgical Wards, patients with intravenous or urinary catheters, traumatic patients, dialysis and ICU patients. Initial severity and mortality were highest in community-acquired SAMSB. In multivariate analysis, risk factors associated with higher mortality were: presence of an ultimately or rapidly fatal underlying disease, acute severity of illness at onset and inadequate empirical treatment. CONCLUSIONS: SAMSB is a clinically severe infection that occurs in patients with baseline disease, especially diabetics, that is almost always related to predisposing risk factors (mainly intravenous catheters). In the presence of a serious baseline disease, the initial critical clinical condition and inadequate empirical treatment are the main prognostic factors associated to greater mortality.

Predictors of mortality in patients with methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia: the role of empiric antibiotic therapy.

The objective of this study was to evaluate prognostic factors and the influence of different empiric antibiotic therapies on outcome and mortality in a cohort of 100 inpatients with bacteraemia (84 cases nosocomial) caused by methicillin-resistant Staphylococcus aureus (MRSA). Patients were investigated by means of a standard protocol at a 944-bed hospital in the years 2000-2004. Empiric antibiotic therapies included vancomycin (n = 49), teicoplanin (n = 20), linezolid (n = 17), other antibiotics active in vitro (n = 7), and inactive antibiotics (n = 7). Overall mortality was 40% (12% among linezolid-treated patients; 46.3% among glycopeptide-treated patients). In bivariate analyses, the following factors were statistically associated with higher mortality: rapidly fatal underlying disease, altered mental status, metabolic acidosis, and acute severe clinical condition at the onset of bacteraemia; development of complications (septic shock, renal failure, and disseminated intravascular coagulopathy); empiric monotherapy with glycopeptides (vs combination therapy with an aminoglycoside); and inadequate empiric treatment. Empiric therapy with linezolid was associated with lower mortality. In multivariate analysis, risk factors associated with higher mortality included acute severity of illness (OR 7.49; 95%CI 1.19-25.3) and altered mental status (OR 4.83; 95%CI 1.22-19.15) at onset, complications (OR 3.42; 95%CI 1.02-17.46), and inappropriate empiric treatment (OR 7.6; 95%CI 1.87-31.14). In multivariate analysis limited to patients who received empiric therapy with either linezolid (n = 17) or glycopeptides (n = 69), linezolid was associated with greater rates of survival (OR 7.7; 95%CI 1.1-53) and microbiological eradication (OR 11.76; 95%CI 1.46-90.9) but not with fewer complications (OR 0.71; 95%CI 0.16-3.25). In conclusion, the main prognostic factors associated with mortality in patients with MRSA bacteraemia are complications, acute severe clinical condition at onset, and inappropriate empiric treatment. Empiric therapy with linezolid was associated with greater survival and more successful microbiological eradication but did not reduce complications.

Bacteriemias por Staphylococcus aureus sensible a meticilina: epidemiología y factores pronósticos. Estudio prospectivo 2000-2003 / Methicillin susceptible Staphylococcus aureus bacteremia: epidemiology and prognostic factors. A prospective study 2000-2003

Introducción. Las bacteriemias por Staphylococcus aureus constituyen un problema significativo en los hospitales por su frecuencia, gravedad y dificultades en el tratamiento; nuestro objetivo es describir los patrones clínico-epidemiológicos, factores pronósticos e influencia del tratamiento antibiótico en la evolución de los pacientes con bacteriemia por Staphylococcus aureus sensible a meticilina (BSASM). Pacientes y métodos. Estudio observacional prospectivo de pacientes ingresados con BSASM (2000-2003). Resultados. Se incluyeron 131 pacientes (edad media, 56 años; 58% ≥ 60 años); el 56,5% de las BSASM eran de origen nosocomial. Del total, un 46% presentaba enfermedad de base (diabetes mellitus fue la más frecuente [28%]); existían factores predisponentes en el 98% (catéter vascular: el 72%); la mortalidad fue del 16% (21/131). El estudio comparativo entre los casos de adquisición nosocomial y comunitaria mostró que los primeros eran más frecuentes en los Servicios Quirúrgicos, en pacientes con catéter vascular, sonda vesical, politraumatismo, diálisis y estancia en Unidad de Cuidados Intensivos (UCI); los casos nosocomiales presentaban mayor gravedad inicial y mortalidad. En el estudio multivariante se asociaron a mayor mortalidad la presencia de una enfermedad de base rápidamente fatal, la situación de gravedad crítica al debut y el uso empírico de antibióticos no adecuados. Conclusiones. La BSASM es una infección de gravedad clínica considerable que se presenta en pacientes con enfermedad de base, especialmente diabéticos, asociada casi siempre a factores predisponentes (catéteres vasculares) y en la que la presencia de una enfermedad de base grave, la situación clínica inicial crítica y el tratamiento empírico inadecuado son los principales factores pronósticos asociados a mayor mortalidad

Background. Staphylococcus aureus bacteremia continues to be a major problem in hospitals due to its high prevalence, severity and treatment difficulties. This study aimed to evaluate epidemiological and clinical features, risk factors and influence of antibiotic choice in outcome and mortality in patients with methicillin susceptible S. aureus bacteremia (SAMSB). Patients and methods. A prospective, observational study of inpatients with SAMSB (2000-3). Results. A total of 131 with SAMSB were included (mean age 56 years; 58% ≥ 60 year-old); 56.5% were due to nosocomial bacteremia; 46% of all patients had an underlying condition (diabetes mellitus being the most frequent [28%]); a risk factor for bacteraemia was identified in 98% (intravenous catheter: 72%). Mortality rate was 16% (21/131). Comparative analysis according to nosocomial or community acquisition showed that the former was more frequent in Surgical Wards, patients with intravenous or urinary catheters, traumatic patients, dialysis and ICU patients. Initial severity and mortality were highest in communityacquired SAMSB. In multivariate analysis, risk factors associated with higher mortality were: presence of an ultimately or rapidly fatal underlying disease, acute severity of illness at onset and inadequate empirical treatment. Conclusions. SAMSB is a clinically severe infection that occurs in patients with baseline disease, especially diabetics, that is almost always related to predisposing risk factors (mainly intravenous catheters). In the presence of a serious baseline disease, the initial critical clinical condition and inadequate empirical treatment are the main prognostic factors associated to greater mortality

Tratamiento de las infecciones urinarias adquiridas en la comunidad: perspectivas actuales y enfoque clínico del paciente / Treatment of community-acquired urinary infections: Current perspectives and patient clinical approach

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EPOC y colonización bacteriana: implicaciones terapéuticas / COPD and bacterial colonization: Therapeutic implications

No disponible

[Clinical patterns of community acquired pneumonia microbiologically documented compared to the not documented.]Prospective and comparative study between 1991 and 1997]. / Patrones clínicos en neumonías comunitarias con documentación y sin documentación microbiológica. Estudio prospectivo y comparativo 1991-1997.

INTRODUCTION: The diagnostic of the pneumonia is the problems more important for its adequate treatment and best evolution. OBJECTIVES: To study in a prospective way the patron clinic de la NAC compared the documented with the not documented in a microbiological way. PATIENTS Y METHODS: We have studied patients with NAC hospitalized in the HUVA between January of 1991 and May of 1997. The diagnostical criterion of pneumonia and of the hospitable ingress were the classics accepted for this infections, was doing in all cases diagnostical studies not invasive. It was analyzed the clinical patron of the NAC microbiologically documented compare to with the not documented. In the same way, the documented was divided in typical and not typical according to the microorganisms aisled. Besides was realized an statistic study using tables of contingency and test Fisher. RESULTS: It was studied 409 patients with NAC, from which 161 (39.6%) had microbiological documentation, it was found 119 micro organism typical and 42 atypical. On the one hand, the female sex, EPOC, fever, tos and purulence esputum and hyperglucaemia, were associated significantly with the documented NAC. The presence of cardiopaty, seriously initial clinical situation, gastrointestinal disorders and previous infections and use of antibiotics, were associated with not documented. The age more than 65 years, presence of comorbility, purulence sputum, pleural pain, toghether with VSG>50 and lobar infiltrate, were associated significantly to typical pneumonia, while tabaquical habit and extrapulmonary sintoms (artromialgias) were with the atypical. CONCLUSIONS: The knowledge of the clinical patrons of the NAC are great impact in the diagnostic and treatment antibiotic adecuate.

Patrones clínicos en neumonías comunitarias con documentación y sin documentación microbiológica. Estudio prospectivo y comparativo / The clinical patron of the nac microbiologically documented compare with the not documented. Prospective and comparative study between 1991 and 1997

Introducción: La dificultad en el diagnóstico clínico de la NAC es uno de los problemas más importantes para su adecuado tratamiento. Objetivos: Estudiar de forma prospectiva el patrón clínico de la NAC comparando las documentadas con las no documentadas microbiológicamente. Pacientes y métodos: Hemos estudiado 409 pacientes diagnosticados de NAC ingresados en el HUVA entre enero de 1991 y mayo de 1997.Los criterios diagnósticos de neumonía y de ingreso hospitalario fueron los clásicos aceptados para estas infecciones. Se analizaron el patrón clínico de las NAC documentadas microbiológicamente de forma comparativa con las no documentadas y las documentadas se dividieron en típicas y atípicas de acuerdo con los microorganismos aislados. Se realizó estudio estadístico mediante tablas de contingencia y test exacto de Fisher. Resultados: De todos ellos 409/161 (39,6 por ciento) tenían documentación microbiológica, encontrándose 119 microorganismos típicos y 42 atípicos. El sexo mujer, la presencia de EPOC, fiebre, expectoración purulenta e hiperglucemia se asociaron significativamente con las NAC documentadas. La presencia de cardiopatía, situación clínica inicial mala, alteraciones gastrointestinales y existencia de infecciones y uso previo de antibióticos, se asociaron significativamente con las no documentadas. La edad mayor de 65 años, presencia de comorbilidad, expectoración purulenta, dolor pleural junto con VSG>50 e infiltrado lobar lo encontramos asociado significativamente a las típicas, mientras que el hábito tabáquico y presencia de síntomas extrapulmonares (artromialgias) lo fueron con la atípicas. Conclusiones: El conocimiento de los patrones clínicos de la NAC es de gran impacto en el diagnóstico precoz y tratamiento antibiótico adecuado (AU)

[Nosocomial fungemias in a general hospital. Epidemiology and prognostic factors. Prospective study 1993-1998]. / Fungemias nosocomiales en un hospital general: epidemiología y factores pronóstico. Estudio prospectivo 1993-1998.

BACKGROUND: Nosocomial fungemias are infections with a high mortality rate. In last years the incidence of these infections has increased probably because of the growing population of immunocompromised patients who undergo aggressive diagnostic and therapeutic techniques. OBJECTIVE: To know the epidemiologic characteristics, risk factors, clinical features and prognosis of fungemia. PATIENTS AND METHODS: We prospectively evaluated all the patients with proven fungemia in our center during a 5 year-period. After finishing antifungal treatment a minimum follow-up of 1 month was carried out. Fungal isolation and identification were performed by standard tests. RESULTS: During the period of study we evaluated 81 patients with an episode of nosocomial fungemia. Global incidence was 0,9 episodes per thousand admitted patients. Candida albicans was the more frequently isolated species (n=53), followed by C. parapsilosis (n=11), C. tropicalis (n=6) and C. glabrata (n=5). Most of the patients had a central intravenous line and were on parenteral nutrition therapy. All of them previously received at least one course of broad-spectrum antibiotics. Overall mortality was 49,6%. A worst prognosis was significantly associated with: age over 65 years, surgical procedures during present admission, leucocytosis, shock, and delay in antifungal treatment. CONCLUSIONS: Fungal bloodstream infection incidence is high in our environment. It is associated with a high mortality rate, specially in patients in whom the beginning of antifungal treatment was delayed. A higher clinical suspicion index may improve the poor outcome in these patients.

Influencia de las infecciones graves por gramnegativos en la economía hospitalaria / Influence of serious infections due to Gram-negative bacteria on the hospital economy

Las infecciones nosocomiales por gramnegativos son de gran importancia al asociarse a una mayor morbilidad y coste hospitalario. Se estudiaron de forma prospectiva 250 enfermos ingresados, de los cuales 200 presentaron infección por microorganismos gramnegativos. Se distribuyeron en grupos de 50 enfermos según la localización de la infección (orina, herida quirúrgica, aparato respiratorio y bacteriemias), con un grupo control de 50 pacientes, de características similares pero sin infección. Calculamos el coste de los diferentes grupos multiplicando la media de días de estancia hospitalaria por el coste de estancia al día. Se observaron diferencias significativas en la estancia media por enfermo según el tipo de infección y el tipo adquisición. Atendiendo al coste, la infección nosocomial por gramnegativos es 1.049.139 pesetas más cara que la adquirida en la comunidad. El coste de la estancia de los pacientes con infección postquirúrgica por gramnegativos fue 1.108.252 pesetas más caro que el de los pacientes del grupo control. La infección nosocomial por gramnegativos se asocia con una prolongación de la estancia hospitalaria entre 9 y 28 días, siendo este hecho el que mejor refleja el coste atribuible a la infección nosocomial. Se requiere estructurar medidas consensuadas y protocolizadas que posibiliten una mejor gestión clínica (AU)

Estudio prospectivo y comparativo (1994-1998) sobre la influencia del tratamiento corto profiláctico con azitromicina en pacientes con EPOC evolucionada / Prospective, comparative study (1994-1998) of the influence of short-term prophylactic treatment with azithromycin on patients with advanced COPD

A pesar de los avances en terapéutica, los pacientes con EPOC requieren frecuentes hospitalizaciones debido a sus exacerbaciones. De forma prospectiva y aleatorizada hemos estudiado dos grupos de pacientes con EPOC. El grupo de estudio (54 pacientes) recibió de forma profiláctica azitromicina (500 mg/día) durante tres días cada 21 días durante todo el periodo invernal, y el grupo control (40 pacientes) no recibió el tratamiento profiláctico. Hemos encontrado una reducción significativa en el número de exacerbaciones (187) y de ingresos hospitalarios (22) en el grupo que recibió azitromicina en comparación con el grupo control (249 y 45, respectivamente). Los ciclos de tratamiento profiláctico corto e intermitente con azitromicina representan una buena opción en los pacientes con EPOC grave y evolucionada, mejorando su coste sanitario y social (AU)

[Risk factors and prognosis of nosocomial pneumonia due to gram-negative bacteria in a general hospital]. / Factores de Riesgo y pronóstico de las neumonías nosocomiales por gramnegativos en un hospital general.

Nosocomial pneumonia due to Gram-negative bacteria is one of the most important infections because of its high frequency, morbidity and mortality. The objective of this study was to determine the risk factors and prognosis for nosocomial pneumonia caused by Gram-negative bacteria. A group of 50 patients with nosocomial pneumonia due to Gram-negative bacteria were studied in a prospective, consecutive manner and compared with another group of 50 patients with similar characteristics but without infection. The diagnostic criteria, acquisition, previous infections, prognosis of the underlying disease, the initial severity of the clinical situation, presence of complications, type and evolution of antibiotic treatment were adjusted according to the criteria in the literature. Univariate and multivariate statistical analysis of the results was carried out. The risk factors found included the following: male sex, high-risk hospital units, nosocomial acquisition and previous manipulation with intubation and mechanical ventilation, previous pulmonary infections, and the use of wide-spectrum antibiotics in the six weeks prior to the study. The most isolated Gram-negative bacterium was Pseudomonas aeruginosa (32%), followed by polymicrobial flora (18%). Bacteriemia was found in 30% of the cases. Mortality was 24%, with the factors significantly associated with a poor prognosis being a serious underlying disease, a clinically critical situation, previous surgery, complications, Gram-negative bacteria, use of wide-spectrum antibiotics in the six months before the study, and advanced age. The mortality of the group was 8%. It was concluded that knowledge of the risk factors and prognosis of nosocomial pneumonia due to Gram-negative bacteria is of high importance to improve treatment and decrease morbidity and mortality.

Factores de riesgo y pronóstico de las neumonías nosocomiales por gramnegativos en un hospital general / Risk factors and prognosis of nosocomial pneumonia due to Gram-negative bacteria in a general hospital

Las neumonías nosocomiales por gramnegativos son una de las infecciones más importantes por su elevada frecuencia y morbimortalidad. El objetivo de este estudio fue valorar los factores de riesgo y pronóstico de las neumonías nosocomiales por gramnegativos. Se estudiaron de forma prospectiva y consecutiva las neumonías nosocomiales por gramnegativos en un grupo de 50 pacientes y se compararon con otro grupo de 50 pacientes, de características similares pero sin infección. Los criterios diagnósticos, tipo de adquisición, antecedentes, pronóstico de la enfermedad de base, situación de gravedad clínica inicial, presencia de complicaciones, tipo de tratamiento antibiótico y evolución, se ajustaron a los criterios de la literatura. Los resultados se sometieron a un análisis estadístico univariante y multivariante. Los factores de riesgo que encontramos fueron el sexo varón, los servicios de alto riesgo, la adquisición nosocomial y las manipulaciones previas del tipo intubación y ventilación mecánica, las infecciones previas pulmonares y el uso de antibióticos de amplio espectro en las seis semanas anteriores. El gramnegativo más aislado fue Pseudomonas aeruginosa (32 por ciento), seguido de flora polimicrobiana (18 por ciento). Se encontró bacteriemia en un 30 por ciento de los casos. La mortalidad fue del 24 por ciento, con factores asociados de forma significativa a un peor pronóstico tales como enfermedad de base grave, situación clínica crítica, cirugía previa, complicaciones, tipo de gramnegativo, uso de antibióticos de amplio espectro en las seis semanas anteriores y edad avanzada. La mortalidad del grupo control fue del 8 por ciento. El conocimiento de los factores de riesgo y pronóstico de las neumonías nosocomiales por gramnegativos es de gran importancia en la mejora de su tratamiento y la disminución de su morbimortalidad. (AU)

[Influence of serious infections due to Gram-negative bacteria on the hospital economy]. / Influencia de las infecciones graves por gramnegativos en la economía hospitalaria.

Nosocomial infections due to Gram-negative bacteria are very important since they are associated with high morbidity and high hospital costs. A prospective study of 250 inpatients was carried out, 200 of whom had Gram-negative bacterial infections. Patients were divided into groups of 50 according to the localization of the infection (urinary, surgical wound, respiratory tract and bacteremia), with a control group of 50 patients with similar characteristics but no infection. We calculated the cost for the different groups by multiplying the average length of hospital stay in days by the daily cost of the stay. Significant differences were observed in the average length of stay per patient according to the type of infection and how it was acquired. In terms of cost, nosocomial infection due to Gram-negative bacteria was 1,049,139 pesetas more expensive than community-acquired infection. The cost of the stay for patients with postsurgical infection due to Gram-negative bacteria was 1,108, 252 pesetas more expensive than for the group of control patients. Nosocomial infection due to Gram-negative bacteria is associated with a prolongation in hospital stay of 9 to 28 days, which is the factor that most reflects the cost that can be attributed to nosocomial infection. Consensual and protocolized measures which allow for better clinical management need to be developed.

[Prospective, comparative study (1994-1998) of the influence of short-term prophylactic treatment with azithromycin on patients with advanced COPD]. / Estudio prospectivo y comparativo (1994-1998) sobre la influencia del tratamiento corto profiláctico con azitromicina en pacientes con EPOC evolucionada.

Despite the advances in therapy, chronic obstructive pulmonary disease (COPD) requires frequent hospital admissions due to acute exacerbations. We carried out a prospective randomized study of two groups of patients with COPD, one (n = 54) treated with azithromycin (500 mg/day) for three days every 21 days during the winter months, and a control group (n = 40) without treatment. A statistically significant reduction in the number of acute infectious episodes (187) and hospital admissions (22) was observed in the treated group versus the control group (249 and 45, respectively). A short prophylactic treatment course with azithromycin is a good alternative in the management of patients with severe, advanced COPD, and could lead to an improvement in social and healthcare costs

Six-year prospective study of risk and prognostic factors in patients with nosocomial sepsis caused by Acinetobacter baumannii.

In this prospective study, the risk factors associated with nosocomial sepsis Caused by Acinetobacter baumannii or Pseudomonas aeruginosa were compared. Prior use of broad-spectrum antibiotics, urinary tract catheter, prior surgery, and mechanical ventilation were significantly associated with nosocomial sepsis caused by Acinetobacter baumannii. The mean prognostic factors significantly associated with mortality were known focus of infection, multiresistant Acinetobacter baumannii, and inappropriate antibiotic treatment. Adequate knowledge of these findings is important to ensure appropriate management of patients and rational use of antibiotics.

[Prospective and comparative study between cefuroxime, ceftriaxone and amoxicillin-clavulanic acid in the treatment of community-acquired pneumonia]. / Estudio prospectivo y comparativo entre cefuroxima, ceftriaxona y amoxicilia-clavulánico en el tratamiento de la neumonía adquirida en la comunidad.

Among community-acquired infections, pneumonia is still a large health problem which is of great interest mainly due its high mortality and morbidity. From 1991 to 1997, 409 patients who had been diagnosed with community-acquired pneumonia and had been admitted to the internal medicine service of a university hospital were prospectively studied. The patients were classified into three groups according to the random antibiotic treatment they had received (ceftriaxone, cefuroxime or amoxicillin-clavulanic acid). The initial characteristics of the patients with regard to epidemiology, clinical description and critical situation were similar in all the groups studied. A total of 36.9% of the cases were documented microbiologically, with the most frequently isolated pathogens being Streptococcus pneumoniae and Haemophilus influenzae. The recovery rate was 92.2% and three patients had a recurrence of pneumonia. Global mortality was 5.8%. No statistically significant differences were found in the evolution of patients treated with cefuroxime, ceftriaxone or amoxicillin-clavulanic acid, with the latter representing an empirical treatment of choice for community-acquired pneumonia.

Effectiveness of immunomodulating treatment (thymostimulin) in chronic obstructive pulmonary disease.

We conducted a prospective randomized study to assess the effect of thymostimulin in patients with long-standing chronic obstructive pulmonary disease (COPD) during a 1-year follow-up. A total of 38 patients in the intervention group and 40 in the control group received standard treatment for COPD. Patients in the intervention group were also given thymostimulin intramuscularly (1 mg/kg day for the 1st week followed by once a week for 6 months). At the end of the study period, patients treated with thymostimulin showed a statistically significant lower number of exacerbations and hospital admissions as compared with controls. However, there were no changes in the number of patients with severe or moderate impairment of respiratory function throughout the study period. No significant differences were found by Multitest or in serum concentrations of immunoglobulins and T-cell subsets before and after thymostimulin treatment. We conclude that treatment with thymostimulin is effective in the prevention of COPD exacerbations acting on the cellular immune response involved in bronchopulmonary defense.