Plan de Intervención Comunitaria para el manejo de la EPOC estable: protocolo de coordinación asistencial y derivación entre farmacias comunitarias y centros de salud / Community Intervention Plan for the management of stable COPD: protocol for care coordination and referral between community pharmacies and health centres

La enfermedad pulmonar obstructiva crónica (EPOC) es una enfermedad frecuente y progresiva, pero prevenible y tratable. Sin embargo, se han detectado importantes áreas de mejora en su diagnóstico, tratamiento y seguimiento, así como en la adherencia terapéutica. Con el propósito de aumentar la detección precoz de la EPOC y su manejo adecuado en España, se ha diseñado un Plan de intervención comunitaria (PIC) para la colaboración entre farmacias comunitarias y centros de salud de atención primaria. El PIC incluye un procedimiento normalizado de trabajo (PNT), desarrollado por un grupo de profesionales de farmacia comunitaria, medicina de familia, neumología y enfermería de atención primaria. En él se describe el algoritmo que guiará la actuación de los farmacéuticos comunitarios, incluyendo las pruebas y dispositivos para el cribado poblacional de la EPOC, la evaluación de la enfermedad, la adhesión a inhaladores y la detección de errores críticos en el uso de inhaladores entre otros aspectos. El PNT incluye también un formulario para la derivación del paciente al centro de salud correspondiente, donde se llevarán a cabo una serie de acciones preestablecidas en el plan de actuación según el escenario clínico. Además, se propone evaluar la efectividad de la intervención con unos indicadores recogidos en el centro de salud y en farmacia comunitaria. Por último, se recomienda establecer un plan formativo en EPOC para la óptima implementación del plan y una encuesta a pacientes sobre su grado de satisfacción con la intervención. En conclusión, la implantación del PIC podría reducir el infradiagnóstico en EPOC y optimizar el manejo de los pacientes diagnosticados en España, donde los farmacéuticos comunitarios tendrían una función esencial en el abordaje de estos pacientes. (AU)

Descripción de la herramienta de sobreuso de salbutamol en SEFAC e_XPERT / Description of the salbutamol overuse tool in SEFAC e_XPERT

JUSTIFICACIÓN: La evidencia actual sugiere que el sobreuso de agonistas ß2 de corta duración (SABAs) no solo podría ser uno de los responsables directos de los altos porcentajes de asma no controlado existente en nuestro país sino también de la mortalidad causada por el asma. Este fenómeno no solo se explica por sus efectos directos sino por ser usados de forma reiterada y abusiva como substitutos del uso regular de los Corticoides Inhalados (ICS) en combinación o no con ß2 agonistas de larga duración (LABAs). Los farmacéuticos comunitarios (FC) por su cercanía, accesibilidad y formación están especialmente posicionados para ayudar a otros profesionales sanitarios a identificar pacientes asmáticos mal controlados o en riesgo de estarlo ofreciéndoles educación sanitaria y derivándolos a la consulta médica en los casos que sea necesario. Este aspecto adquiere especial relevancia en la detección de abuso o sobreuso de SABAs que además suele venir acompañado de una baja adherencia al tratamiento antinflamatorio de mantenimiento.OBJETIVOS: descripción de la herramienta de sobreuso de Saba desarrollada en SEFAC e_XPERT.MATERIAL Y MÉTODOS: la herramienta de Sobreuso de SABA desarrollada en SEFAC e_XPERT se encuentra disponible en la página web https://www.sefacexpert.org/a/registry-campaign-workplace/1 y dispone de diferentes tests para llevar a cabo como la Regla del Asma, el Test de Adhesión a los Inhaladores (TAI), y el Test de Control del Asma (ACT), para evaluar el uso excesivo de SABA, el manejo de los dispositivos de inhalación y el control de la patología asmática. (AU)

Programa de capacitación ‘cesar’: evolución descriptiva de los alumnos inscritos desde octubre de 2020 hasta la actualidad / Cesar' training programme: descriptive evolution of enrolled trainees from October 2020 to the present day

JUSTIFICACIÓN: la farmacia comunitaria tiene un papel fundamental en el proceso de cesación tabáquica. CESAR es una capacitación integral en cesación tabáquica para farmacéuticos comunitarios (FC), mediante una formación teórico-práctica y clínica completa de tres fases con una recapacitación periódica.OBJETIVO: conocer el estado de situación de los FC inscritos en las últimas 4 ediciones (2020-2022).MATERIAL Y MÉTODOS: estudio descriptivo retrospectivo. Se estudia el número de FC inscritos, el porcentaje que ha superado cada fase y finalizado el programa. Comparando las 4 ediciones. FASES: Fase 1: teórica online. Fase 2: práctica. Fase 3: clínica: 3 registros en SEFAC e_XPERT. Se recogen y analizan los datos de los FC inscritos en las 4ª ediciones. Excepto la 1ª, las ediciones están abiertas.RESULTADOS: el número total de inscritos durante el período 2020- febrero de 2022 fue de 293, siendo 39 socios de SEFAC. Por CCAA; destacan la C. Valenciana e Islas Baleares con un 23,45 % de los inscritos; Región de Murcia, Aragón, Castilla La Mancha, C. de Madrid y Galicia entre 11,11 y 6,17 %; Andalucía, Castilla y León, Canarias y Cataluña <5 %.El 97,2 % de los alumnos han necesitado una matrícula para superar el curso. El 1,40 % de los inscritos no está en activo. El 77,77 % de los inscritos son mujeres, el 22,22 % hombres. (AU)

Experiencia SEFAC Semana Sin Humo 2021 / Experience SEFAC Smoke-free Week 2021

JUSTIFICACIÓN: para el Día Mundial Sin Tabaco, Fundación SEFAC y SEFAC, realizaron su campaña “Semana Sin Humo 2021”, en redes sociales dirigida tanto a Farmacéuticos Comunitarios como a pacientes, para concienciar a ambos de que el farmacéutico comunitario puede ayudar de manera eficaz a dejar de fumar. Objetivos: -Potenciar y dar herramientas que empoderen a los farmacéuticos comunitarios para realizar el consejo breve a través de videos cortos formativos e informativos.-Informar, promover y dar a conocer entre los pacientes la oportunidad del cese tabáquico que de manera accesible y profesional pueden hacer en la farmacia comunitaria.MATERIAL Y MÉTODOS: se editaron 6 videos cortos realizados por FC del grupo de Respiratorio y Tabaquismo de SEFAC, difundidos en las redes sociales (Twitter e Instagram) durante la “Semana Sin Humo 2021”, 4 dirigidos a farmacéuticos comunitarios y 2 a pacientes.RESULTADOS: durante la duración de la campaña, los videos tuvieron un total de 3167 visualizaciones, con una media de 527,8 por video. Los dirigidos a los farmacéuticos comunitarios tuvieron una media de 488 visualizaciones, frente a 607,5 los de los pacientes. Contenido del vídeo. Visualizaciones. Las 5As del consejo breve para ayudar a dejar de fumar en farmacia comunitaria 880 'Semana sin humo': cinco razones para dejar de fumar 665 Intervención según el tipo de paciente fumador 425¿Qué tratamientos pueden encontrarse en la farmacia comunitaria? 550Caso práctico: intervención breve en cesación tabáquica 291 Guía de actuación farmacéutica a pie de mostrador: la terapia sustitutiva con nicotina 356 TOTAL3.167 (AU)

[Infection and colonization by Scedosporium prolificans]. / Infección y colonización por Scedosporium prolificans.

BACKGROUND: Scedosporium prolificans is a dematiaceous fungus that is known to cause a wide spectrum of infections in humans, bearing a severity and a prognosis that is relationed with the patients immune status. METHODS: A retrospective review was made of the clinical charts of all patients who developed positive S. prolificans cultures in our centre from 1990 to 2000. Isolates were identified by colonial morphology and microscopic features. The in vitro susceptibility was evaluated using the microdilution method according to NCCLS. RESULTS: S. prolificans was isolated in 15 patients. Eight were affected with cystic fibrosis and the isolation of S. prolificans in their airways did not worsen their clinical status. Among the remaining 7 cases there were five leukemic patients with neutropenia and two immunocompetent hosts with cutaneous infection and endocarditis. Four of five neutropenic patients died of sudden sepsis and S. prolificans was isolated from blood cultures made a few days before their death, and the fifth neutropenic case suffered a bilateral pneumonia with improving course probably due to recovery from neutropenia. As to the immunocompetent group the clinical course was good in the cutaneous infection case, but the endocarditis case died four days after the antifungical therapy was started. All the isolates tested were found to be resistant to amphotericin, 5 flucytosine, fluconazole, itraconazole, voriconazole, miconazole and terbinafine. CONCLUSIONS: Scedosporium prolificans is a fungal pathogen that colonizes the airways of patients affected with cystic fibrosis. It can also cause a wide variety of infections, whose severity and prognosis depends on the patients immune status. Due to the resistance of this fungus to antifungal drugs, the therapeutic options are limited. Only with the correction of neutropenia and surgery in local infections in immunocompetent hosts it has been possible to cure these infections.

[Keratitis caused by Acanthamoeba spp.: presentation of 10 cases]. / Queratitis por Acanthamoeba spp.: presentación de diez casos.

OBJECTIVE: To describe the clinical and microbiological characteristics of ten patients with Acanthamoeba spp. keratitis. METHODS: A retrospective review was made of the clinical charts of ten patients with both clinical keratitis and positive culture for Acanthamoeba spp. from 1992 (date of first diagnosed case in our hospital) on. Corneal tissue was cultured in Page media and also the contact lenses and maintenance or cleaning fluids used by each patient. RESULTS: The earliest clinical symptom observed in 60% of cases was foreign-body sensation. Before the parasitologic studies all the patients received different treatments for 4 days minimum to a maximum of 3 months. On ophthalmological examination the findings were: radial perineuritis in 4 cases, anular infiltrate in two, keratitis punctata in two and pseudodendritic ulcer in two more. Treatment employed was the following: propamidine and neomycin in 8 patients (four of them also received ketoconazole); biguanides in two. After a mean observation time of 7 months (minimum 4, maximum 10) the clinical status was favorable in 70% of cases. In three patients with delayed diagnosis of 2 to 3 months a keratoplasty was needed. COMMENTS: Acanthamoeba spp. keratitis is a process of difficult diagnosis and treatment. For early detection of this disease a narrow collaboration with the microbiologist is mandatory because the prognosis in this patients depends on the precocity of treatment.

Genetic similarity among one Aspergillus flavus strain isolated from a patient who underwent heart surgery and two environmental strains obtained from the operating room.

We report the simultaneous isolation of one Aspergillus flavus strain from the aortic prosthesis of a heart surgery patient and another two isolates recovered from a dual-reservoir cooler-heater used in the operating room where this patient was operated on. Genetic typing of these three isolates by randomly amplified polymorphic DNA (RAPD) revealed identical genotypes. Eight unrelated control strains of A. flavus had eight different genotypes. These results clearly indicated the nosocomial origin of the A. flavus strain isolated from the patient. We suggest that the RAPD technique is a rapid and reliable tool to ascertain the epidemiology of infections caused by A. flavus.

[Meningitis by enterovirus in pediatrics. Clinical characteristics and virologic diagnosis]. / Meningitis por enterovirus en pediatría. Características clínicas y diagnóstico virológico.

BACKGROUND AND METHODS: With the aim of knowing the etiology of aseptic meningitis (pleocytosis in LCR with negative bacterial culture and positive or negative virus culture or without pleocytosis with viral culture in positive LCR), 48 children attending the Emergency Department of our hospital from June to December, 1995 were prospectively studied. Pharyngeal and rectal swab, LCR for bacteria and virus and blood cultures were carried out. The samples were inoculated in fibroblasts MRC-5, RD and BGM. The cytopathic effect was identified by immunofluorescence. Typing was performed in the National Center of Public Health Care Microbiology, Virology and Immunology in Majadahonda (Spain). RESULTS: Isolation of the virus was positive in 40/48 (83.3%) of the children: in 17 (35.5%) of LCR and the remaining 23/40 (47.9%) of pharyngeal and/or rectal swab. In all the cases the cytopathic effect was detected in MRC-5. The viruses found were echovirus 30 and 5. A greater incidence of the disease was observed in November and December. CONCLUSIONS: Meningitis by enterovirus is frequent in our area. Culture of the virus in LCR, the pharynx and stools is useful on suspicion of aseptic meningitis since the virus may be isolated from LCR in more than one third of the patients. Serotyping aids in surveilling the appearance of outbreaks and to know the predominant viruses. Cell culture is the diagnostic treatment of choice, but has a low sensitivity and is slow. The application of other techniques such as PCR which have a greater sensitivity and with high specificity for the diagnosis of these infections is necessary.

Deep infections caused by Scedosporium prolificans. A report on 16 cases in Spain and a review of the literature. Scedosporium Prolificans Spanish Study Group.

Scedosporium prolificans, a mold morphologically similar to Scedosporium apiospermum, may cause asymptomatic colonization or localized or disseminated infection following trauma, surgery, and immunosuppression. S. prolificans is normally resistant to available antifungal agents, and prognosis depends largely on the host's immune status, extent of infection, and feasibility of surgical debridement. We report on 16 patients with deep S. prolificans infections, focusing on predisposing factors, clinical characteristics, outcome, postmortem findings, and antifungal susceptibility testing to 6 antifungal agents. Between 1989 and 1994, 16 cases of deep infections by S. prolificans were documented in 6 clinical centers in Spain (15 adults and 1 child: male/female = 0.77). Fifteen patients had underlying hematologic malignancy (14 with neutropenia) and 1 had a prosthetic cardiac valve. Syndromes included disseminated infection in 14 patients (1 with prosthetic valve endocarditis) and fungal pneumonia and meningoencephalitis in 1 patient each. S. prolificans was isolated from 2 specimens in 14 patients and from 1 specimen in 2 patients (blood, n = 12; respiratory tract, n = 4; CNS, n = 4; and skin biopsy, n = 3). Antifungal susceptibility testing by a micromethod with RPMI-2% glucose medium was performed in 8 isolates, all of which were resistant to amphotericin B, flucytosine, ketoconazole, fluconazole, itraconazole, and miconazole. All patients received antifungal therapy (amphotericin B, n = 9; amphotericin B+ flucytosine, n = 1; amphotericin B+ itraconazole, n = 2; liposomal amphotericin B+ itraconazole, n = 1; amphotericin B+ fluconazole, n = 1 and 2 underwent surgical procedures. Two patients survived coinciding with hematologic recovery and 14 (87.5%) patients died in a median time of 4 days after the first positive culture (range, 0-60 d). Necropsy was performed in 10 patients, and disseminated infection was found in 9. In conclusion, S. prolificans is an emerging multiresistant fungal pathogen that may cause asymptomatic colonization, localized infection related to trauma or surgery, and rapidly fatal disseminated infection in immunocompromised hosts, particularly those with neutropenia. This mycosis underscores the urgent need for new antifungal agents.

[Hemorrhagic colitis caused by verotoxigenic Escherichia coli. Presentation of 9 cases]. / Colitis hemorrágica por Escherichia coli verotoxigénica. Presentación de 9 casos.

OBJECTIVE: To describe the clinical and epidemiological characteristics of nine patients with enteritis caused by verocytotoxin-producing E. coli O157. PATIENTS AND METHODS: Clinical data of patients was collected retrospectively, the isolated strains were tested for verotoxin production (VT) using Vero cell culture line, and presence of VT1 and VT2 gene sequences was detected using amplification techniques (PCR), biotype was also determined using twelve biochemical tests, and genomic macrorestriction profile (PFGE). RESULTS: The patients' age ranged from 11 months to 70 years. The mean duration of diarrhea was 4.7 days. All patients but one had abdominal cramps, seven of nine reported hemorrhagic stools and six had fever. Three patients were affected of haematologycal neoplasia and two of them developed hemolytic-uremic syndrome as a complication. All strains produced VT2 and two of them also produced VT1. Epidemiological link between patients has not been established. Three different biotypes had been distinguished between the nine isolated strains. All but two had different macrorestriction profiles. DISCUSSION: The results obtained showed that clinical manifestations are rather inespecific, including fever (6/9 patients) and there is high association of severe complications. The heterogeneity in PFGE results obtained confirms that the cases are not related.

[Hemolytic-uremic syndrome caused by Escherichia coli O157:H7. Detection in direct sample of verotoxin-coding genes]. / Síndrome hemolítico-urémico causado por Escherichia coli O157:H7. Detección en muestra directa de genes codificadores de verotoxina.

Hemorrhagic colitis is an enteritis caused by verotoxigenic strains of Escherichia coli. Conventional diagnosis requires the identification of the microorganism and the demonstration of verotoxin production. The determination of toxigenicity in isolated strains and in direct stool samples by the polymerase chain reaction (PCR) technique may simplify the diagnosis. Conventional coprocultures were performed for the detection of verotoxigenic E. coli O157:H7 from three stool samples of a patient with hemorrhagic colitis and hemolytic-uremic syndrome. The production of verotoxin was determined by cell culture and the presence of VT1 and VT2 genomic sequences by PCR. Likewise, the latter technique was applied to a direct stool sample for detection of the verotoxin codiying genes. The specificity of the amplified sequences was confirmed by enzyme restriction digestion. Escherichia coli O157:H7 was isolated in two of the three samples studied. The strains were toxigenic in the cell culture test at titers higher than 1/500 and PCR showed an amplified band of 479 pb corresponding to the VT2 codifying gene. The digestion of amplified sequences with the EcoRV enzyme led to two bands of 390 and 89 pb confirming the specificity of the results. One of the two stool samples studied directly by PCR was positive for VT2 with the result being obtained 48 hours after arrival to the laboratory. The preliminary results of this study give support to the usefulness of the polymerase chain reaction technique in the detection of verotoxin from isolated strains of Escherichia coli and in direct stool samples.

Influence of three factors on the diagnostic effectiveness of transthoracic needle aspiration in pneumonia.

Prior antibiotic therapy, size of the infiltrate, and the person who performed the technique were the three factors that we studied to assess their influence on the effectiveness of transthoracic needle aspiration (TNA). Ninety-one patients with a diagnosis of severe bacterial pneumonia, who underwent TNA, have been included in the study. The technique was carried out with an ultrathin needle gauge 25 and without fluoroscopic control. A univariate (UA) and a multivariate statistical analysis were made. The sensitivity of TNA was 34.1%. Fifty-seven of 91 (62.6%) had received antibiotic therapy prior to TNA; sensitivity was higher in nontreated patients than in treated patients (p = 0.0033; UA). There were 34 patients with an infiltrate that was smaller than a lobe (MINLOB); 39 cases affected a complete lobe (LOB) and 18 more than one lobe (MAJLOB). The TNA sensitivity was higher in LOB cases than in MINLOB cases (p = 0.0004; UA) while when comparing LOB cases and MAJLOB cases, sensitivity was higher in the former (p = NS; UA). In 28 of 91 cases (30.8%), the TNA was performed by A (a trained physician who regularly carries out the technique) and in 63 of 91 cases (69.2%) by B (other physicians, 10 in our study, who sporadically perform the technique). The TNA sensitivity was higher when the technique was performed by A, although this difference was not significant; if we add negative TNA with leukocytes present in Gram stains (which would indicate that aspiration was done in the correct area) to positive TNA, the difference between A and B was higher (p = 0.0248). The multivariate statistical analysis confirmed that there are two variables that are independently connected to a positive TNA (prior antibiotic therapy and size of the infiltrate). As regards the variable "person who carries out the technique," a significant association with a positive TNA was not established, although the estimations we obtained show a possible clinical relevance.

[Pneumonia in alcoholic patients: the clinical and etiological characteristics]. / Neumonía en pacientes alcohólicos: características clínicas y etiológicas.

Twenty-four alcoholic patients with community-acquired pneumonia were studied for 2 years in order to define clinical signs and etiology. Blood cultures and serological profiles were done for all patients in addition to standard blood analyses. All had an invasive procedure -transthoracic puncture with an ultrafine 25G needle (20 patients) or telescopic catheter with bacteriologic brush (4 patients). When we were unable to obtain a good sputum sample (5 patients), a culture was grown. The patients' mean age was 48 and 83% had an acute clinical profile (< or = 7 days with symptoms) with "typical" signs. The X-rays showed an alveolar pattern in all patients, with cavitation in 29%. Etiological diagnosis was reached in 17 (71%) cases, with St. Pneumoniae (25%), anaerobic microorganisms (20%) and C. burnetii (12.5%) being the germs found most frequently. The invasive techniques were more useful (54%) than the blood cultures (17%) or sputum cultures (4%), and they were well tolerated and uncomplicated. Empirical antibiotic treatment was modified for 12 patients (50%). Seventeen percent required intensive care treatment and mortality was 12.5%.

[Current use of penicillin in community-acquired pneumococcal pneumonias]. / Actualidad de la penicilina en las neumonías neumocócicas extrahospitalarias.

BACKGROUND: A retrospective study was performed to know the clinical and microbiologic aspects of community-acquired pneumococcal pneumonia in adult patients admitted to a general hospital from 1990-1992. METHODS AND RESULTS: The medical records of 55 patients, aged 20-86 years (man age: 58 year) were reviewed. Streptococcus pneumoniae was isolated from blood in 45 cases (81.8%), transparietal lung puncture in 5 (9.1%), pleural fluid 3 (5.5%) and protected specimen brushing (> 1,000 UFC/ml) in 2 (3.6%) Most isolated (80%) were sensitive to penicillin (CIM < 0.1 microgram/ml); intermediate (CIM > or = 0.1 microgram/ml) 9 (16.4%) and resistant (> 1 microgram/ml) 2 (3.6%). Underlying diseases were present in 39 (70.9%) cases. All patients received empiric treatment with one or more antibiotics effective against Streptococcus pneumoniae. Only in 2 of the 9 cases treated with erythromycin the microorganism was resistant to this drug. Eleven patients died (20%), 5 died before to the fifth day of admission. Mortality was influenced by involvement of 2 or more lobes and immunosuppression (p < 0.05). CONCLUSIONS: This study suggests that 80% of the community-acquired pneumococcal pneumonia in a population with a high prevalence rate of disease requiring hospital admission are very sensitive in vitro to penicillin in contrast with its seldom clinical use in the authors environment. No microorganism presented with CIM above 2 micrograms/ml. Mortality was not due to inadequate therapy but rather to the severity of the underlying disease.

[Clinical and etiological features of community-acquired pneumonia in the elderly]. / Características clínicas y etiológicas de la neumonía adquirida en la comunidad en ancianos.

BACKGROUND: The aim of the present study was to know the clinical and etiologic features of community-acquired pneumonia (CAP) in elderly patients requiring hospital admission. METHODS: A prospective study of 36 consecutive patients aged over 70 years, admitted to a general hospital was performed. Standard analytical determinations, blood cultures, and serologic studies were performed in all patients using invasive techniques: aspirative transthoracic puncture (ATP) with ultrafine needle in 35 (97%) cases, and telescopic catheter (TC) in 1 case. RESULTS: The mean age was 79 years (range: 71-90). Twenty-two patients had received antibiotic treatment prior to admission (61%) and 17 (47%) presented chronic debilitating diseases. The clinical characteristics of CAP were "typical" with acute presentation in most. Fifteen cases (42%) were etiologically diagnosed and the most frequently isolated agents were Streptococcus pneumoniae (22%) and Haemophilus influenzae (8%). Empiric treatment was changed on the basis of isolations in 7 cases (19%). Eight patients died (22%). CONCLUSIONS: According to our results community-acquired pneumonia in the population studied: 1) generally showed an acute presentation with "typical" characteristics, carrying a high mortality rate (22%), 2) is of bacterial etiology, with S. pneumoniae and H. influenzae being the most frequently isolated microorganisms, 3) the use of ATP in community-acquired pneumonia offers a high diagnostic effectiveness, good tolerance and low risk of complications.

[Transthoracic aspiration punction with ultrafine needle in high risk community acquired pneumonia]. / La punción transtorácica aspirativa con aguja ultrafina en las neumonías de alto riesgo adquiridas en la comunidad.

BACKGROUND: The identification of etiologic agents of pneumonias acquired in the community (PAC) with risk factors is difficult. The classical diagnostic methods are not profitable and thus invasive techniques are used. In this study the diagnostic use of an invasive technique such as aspirative transthoracic puncture (ATP) was evaluated in this type of pneumonias. METHODS: In 94 patients of high risk suspect of PAC the ATP was carried out. This was performed with an ultrafine needle (25G) without radioscopic control. In all cases blood cultures, serology (Legionella, Mycoplasma pneumoniae, Coxiella burnetti, Chlamydia psittaci) were performed when atypical clinical manifestations were presented and sputum examination (Gram, Ziehl, culture) was undertaken when possible. RESULTS: The sensitivity of ATP was 36% and increased to 54.6% in cases previously untreated with antibiotics. Specificity was 96.4%. The sensitivity of blood culture was 8% and sputum 13.6%. ATP was well tolerated in 97.9% with complication in only 4 (4.3%). The results of ATP led to changes in treatment in 23.1% of the cases with definitive diagnosis of pneumonia. CONCLUSIONS: Aspirative transthoracic puncture with ultrafine needle without fluoroscopic control was a very well tolerated technique with a minimum number of complications, easy to perform at the patients bedside and was used to modify treatment in 23.1% of the cases.