[Methicillin-resistant Staphylococcus aureus in patients with cystic fibrosis]. / Staphylococcus aureus resistente a meticilina en pacientes adultos con fibrosis quística.

OBJECTIVE: To determine the prevalence of chronic colonization with methicillin-resistant Staphylococcus aureus (MRSA) in patients with cystic fibrosis, describe antibiotic sensitivity of the strains, and compare the patients' clinical characteristics with those of patients infected with methicillin-sensitive S. aureus (MSSA). PATIENTS AND METHODS: Patients with chronic S. aureus colonization were selected from a total of 50 patients with cystic fibrosis. Sputum samples were cultured according to standard microbiological procedures. Patients were considered to have chronic bronchial colonization if the same microorganism was isolated in 3 consecutive sputum samples, separated by an interval of at least 1 month. The following variables were compared between patients with MSSA (17) and MRSA (8): sex, body mass index, presence of pancreatic insufficiency, bacterial colonization, pulmonary function, Brasfield radiological score, Shwachman clinical score, and number of respiratory exacerbations in the previous year. RESULTS: The prevalence of infection by MRSA was 16%. All the MRSA strains were sensitive to vancomycin, teicoplanin, and linezolid. Patients with MRSA were older and had a larger number of respiratory exacerbations than patients with MSSA. CONCLUSIONS: There is a high percentage of colonization by MRSA in adult cystic fibrosis patients. Although the pathogenic role of this microorganism remains unclear, patients with MRSA had more frequent exacerbations and poorer lung function. Thus, infection control is important and patients should be adequately monitored.

Staphylococcus aureus resistente a meticilina en pacientes adultos con fibrosis quística / Methicillin-resistant Staphylococcus aureus in patients with cystic fibrosis

Objetivo: valorar la prevalencia de colonización crónica por Staphylococcus aureus resistente a meticilina (SARM) en pacientes con fibrosis quística, describir la sensibilidad antibiótica de las cepas, así como comparar las características clínicas con los pacientes con S. aureus sensible a meticilina (SASM). Pacientes y métodos: de un total de 50 pacientes con FQ se seleccionó a los colonizados crónicamente por S. aureus. Las muestras de esputo se cultivaron según los procedimientos microbiológicos habituales, se consideró colonización bronquial crónica el aislamiento de un mismo microorganismo en más de 3 muestras respiratorias consecutivas con un intervalo mínimo de 1 mes entre ellas. Se compararon las siguientes variables entre los pacientes con SASM (n=17) y aquellos con SARM (n=8): sexo, índice de masa corporal, insuficiencia pancreática, colonización bacteriana, función pulmonar, puntuaciones radiológicas de Brasfield y clínica de Shwachman y número de exacerbaciones respiratorias en el año previo. Resultados: la prevalencia de infección por SARM fue del 16%. El 100% de las cepas SARM fueron sensibles a vancomicina, teicoplanina y linezolid. Los enfermos con SARM tenían más edad, peor estado clínico y mayor número de exacerbaciones respiratorias que los pacientes con SASM. Conclusiones: hay un alto porcentaje de colonización por SARM en los pacientes adultos con fibrosis quística. Aunque el papel patogénico de esta bacteria está aún por determinar, parece que los pacientes con SARM tienen un peor estado clínico y presentan muchas exacerbaciones, por lo que la instauración de medidas de control y vigilancia es importante (AU)

Objective: To determine the prevalence of chronic colonization with methicillin-resistant Staphylococcus aureus (MRSA) in patients with cystic fibrosis, describe antibiotic sensitivity of the strains, and compare the patients¿ clinical characteristics with those of patients infected with methicillin-sensitive S. aureus (MSSA). Patients and methods: Patients with chronic S. aureus colonization were selected from a total of 50 patients with cystic fibrosis. Sputum samples were cultured according to standard microbiological procedures. Patients were considered to have chronic bronchial colonization if the same microorganism was isolated in 3 consecutive sputum samples, separated by an interval of at least 1 month. The following variables were compared between patients with MSSA (17) and MRSA (8): sex, body mass index, presence of pancreatic insufficiency, bacterial colonization, pulmonary function, Brasfield radiological score, Shwachman clinical score, and number of respiratory exacerbations in the previous year. Results: The prevalence of infection by MRSA was 16%. All the MRSA strains were sensitive to vancomycin, teicoplanin, and linezolid. Patients with MRSA were older and had a larger number of respiratory exacerbations than patients with MSSA. Conclusions: There is a high percentage of colonization by MRSA in adult cystic fibrosis patients. Although the pathogenic role of this microorganism remains unclear, patients with MRSA had more frequent exacerbations and poorer lung function. Thus, infection control is important and patients should be adequately monitored (AU)

[Polymyositis and interstitial lung disease with a favorable response to corticosteroids and methotrexate]. / Polimiositis y afectación pulmonar intersticial con buena respuesta a glucocorticoides y metotrexato.

Polymyositis is a rare collagen disease that can involve the lungs. Between 5% and 30% of patients with polymyositis present interstitial lung disease at diagnosis or during the course of disease. Onset is usually insidious and involves dyspnea and nonproductive cough. Several histopathological findings are associated with polymyositis and the most common is nonspecific interstitial pneumonia. The prognosis of interstitial lung disease associated with polymyositis is better than that of idiopathic pulmonary fibrosis, since most patients respond to treatment with corticosteroids and immunosuppressants. We report the case of a 60-year-old woman with dyspnea and muscle weakness who was diagnosed with polymyositis and interstitial lung disease (radiography indicated possible nonspecific interstitial pneumonia). The patient responded well to prednisone and methotrexate.

Polimiositis y afectación pulmonar intersticial con buena respuesta a glucocorticoides y metotrexato / Polymyositis and interstitial lung disease with a favorable response to corticosteroids and methotrexate

La polimiositis es una colagenopatía rara, que puede afectar al pulmón. Entre un 5 y un 30% de los pacientes con polimiositis presenta una enfermedad pulmonar intersticial en el momento del diagnóstico o durante el curso de la enfermedad. El inicio suele ser insidioso en forma de disnea y tos seca. Son varias las entidades histopatológicas que se asocian a polimiositis, de las cuales la más frecuente es la neumonía intersticial no específica. El pronóstico de la enfermedad pulmonar intersticial difusa asociada a polimiositis es mejor que el de la fibrosis pulmonar idiopática, ya que la mayoría de los pacientes responde al tratamiento con glucocorticoides e inmunodepresores. Presentamos el caso clínico de una mujer de 60 años con síntomas de disnea y debilidad muscular, a quien se diagnosticó de polimiositis y enfermedad pulmonar intersticial difusa (posible neumonía intersticial no específica por hallazgos radiológicos), y que mostró buena respuesta al tratamiento con prednisona y metotrexato

Polymyositis is a rare collagen disease that can involve the lungs. Between 5% and 30% of patients with polymyositis present interstitial lung disease at diagnosis or during the course of disease. Onset is usually insidious and involves dyspnea and nonproductive cough. Several histopathological findings are associated with polymyositis and the most common is nonspecific interstitial pneumonia. The prognosis of interstitial lung disease associated with polymyositis is better than that of idiopathic pulmonary fibrosis, since most patients respond to treatment with corticosteroids and immunosuppressants. We report the case of a 60-year-old woman with dyspnea and muscle weakness who was diagnosed with polymyositis and interstitial lung disease (radiography indicated possible nonspecific interstitial pneumonia). The patient responded well to prednisone and methotrexate

[Efficiency of the home intravenous antibiotics treatment in cystic fibrosis]. / Eficiencia del tratamiento antibiótico intravenoso domiciliario en la fibrosis quística.

BACKGROUND AND OBJECTIVE: The objective of our study was to determine the costs saving with the implementing of a home intravenous antibiotic treatment (HIVAT) program for patients with cystic fibrosis and to compare it with the conventional system (inpatient). PATIENTS AND METHOD: Consecutive patients in an adults cystic fibrosis unit were selected who received some days of HIVAT, between January 2002 and December 2004. For the analysis of costs saving of the HIVAT, we used the difference between the total costs of the avoided stay days and the costs generated by the domiciliary therapy (drugs, expendable equipment) and by the ambulatory medicine unit in case the patients were not hospitalized. All patients received a therapy with an intravenous antibiotic for a minimum of 14 days. All these data were provided by the accounting service of the hospital with the aid management Clinical Financier Program (GECLIF). RESULTS: 22 patients with cystic fibrosis needed 85 intravenous antibiotics treatments during the 3 years of the study, of which: 43 cycles were completely domiciliary, 14 inpatient and 28 were combined (hospital and home). The 71 cycles of HIVAT originated 909 days at home, with an average (standard deviation) of 12.80 (4.18) days and 43 treatments in ambulatory medicine unit. The home antibiotic treatments that originated greater cost (3,964.34 Euro) was meropenem (1 g/6 h) i.v. with linezolid (600 mg/12 h) via oral combination during 14 days, and in second place the association of ceftazidime, tobramycine and linezolid, whose cost in cycle of 14 days was of 2464.84 Euro. The average saving cost in the 3 years of study was of 2,647.29 Euro by each cycle of HIVAT and global 197,689.78 Euro. CONCLUSIONS: HIVAT obtained important sanitary costs saving and this was greater every year, not due to the increase of days at home, but due to the rising cost per day of hospital stays every new year.

Eficiencia del tratamiento antibiótico intravenoso domiciliario en la fibrosis quística / Efficiency of the home intravenous antibiotics treatment in cystic fibrosis

Fundamento y objetivo: El objetivo de nuestro trabajo ha sido estimar el ahorro de costes derivado de la implantación de un programa de tratamiento antibiótico intravenoso domiciliario (TAIVD), frente al esquema terapéutico tradicional (con ingreso hospitalario), en pacientes con fibrosis quística. Pacientes y método: Se incluyó consecutivamente en el estudio a los pacientes pertenecientes a una unidad de adultos de fibrosis quística que recibieron algún día TAIVD durante el período comprendido entre enero de 2002 y diciembre de 2004. Para el análisis de ahorro de costes del TAIVD se calculó la diferencia entre los costes de las estancias brutas evitadas y los generados por el tratamiento domiciliario (fármacos, material fungible) y en el hospital de día, en el caso de que el paciente no hubiese ingresado en el hospital. Todos los pacientes recibieron tratamiento antibiótico intravenoso un mínimo de 14 días. Los datos económicos fueron proporcionados por el Servicio de Contabilidad del hospital con la ayuda del programa de Gestión Clínico-Financiera (GECLIF). Resultados: Durante los 3 años del estudio 22 pacientes con fibrosis quística recibieron 85 ciclos de tratamiento antibiótico intravenoso; 43 fueron íntegramente domiciliarios; 14, hospitalarios y 28, mixtos (hospital y domicilio). Los 71 ciclos de TAIVD (incluidos los 28 mixtos) se desglosaron en 909 días en domicilio, con una media (desviación estándar) de 12,80 (4,18) días y 43 estancias en el hospital de día. Los tratamientos antibióticos que originaron mayor gasto en el domicilio (3.964,34 e) fueron la combinación de meropenem (1 g/6 h) intravenoso con linezolid (600 mg/12 h) por vía oral durante 14 días y, en segundo lugar, la asociación de ceftazidima, tobramicina y linezolid, cuyo gasto en un ciclo de 14 días fue de 2.464,84 e. El ahorro medio en los 3 años de estudio se estimó en 2.647,29 e por cada ciclo de TAIVD, y de forma global, en 197.689,78 e. Conclusiones: La implantación del programa de TAIVD supuso un importante ahorro de costes. Dicho ahorro fue mayor cada año, dado que el coste de la estancia hospitalaria se elevó de forma considerable cada año transcurrido

Background and objective: The objective of our study was to determine the costs saving with the implementing of a home intravenous antibiotic treatment (HIVAT) program for patients with cystic fibrosis and to compare it with the conventional system (inpatient). Patients and method: Consecutive patients in an adults cystic fibrosis unit were selected who received some days of HIVAT, between January 2002 and December 2004. For the analysis of costs saving of the HIVAT, we used the difference between the total costs of the avoided stay days and the costs generated by the domiciliary therapy (drugs, expendable equipment) and by the ambulatory medicine unit in case the patients were not hospitalized. All patients received a therapy with an intravenous antibiotic for a minimum of 14 days. All these data were provided by the accounting service of the hospital with the aid management Clinical Financier Program (GECLIF). Results: 22 patients with cystic fibrosis needed 85 intravenous antibiotics treatments during the 3 years of the study, of which: 43 cycles were completely domiciliary, 14 inpatient and 28 were combined (hospital and home). The 71 cycles of HIVAT originated 909 days at home, with an average (standard deviation) of 12.80 (4.18) days and 43 treatments in ambulatory medicine unit. The home antibiotic treatments that originated greater cost (3,964.34 e) was meropenem (1 g/6 h) i.v. with linezolid (600 mg/12 h) via oral combination during 14 days, and in second place the association of ceftazidime, tobramycine and linezolid, whose cost in cycle of 14 days was of 2464.84 e. The average saving cost in the 3 years of study was of 2,647.29 e by each cycle of HIVAT and global 197,689.78 e. Conclusions: HIVAT obtained important sanitary costs saving and this was greater every year, not due to the increase of days at home, but due to the rising cost per day of hospital stays every new year