Consenso español para la prevención y el tratamiento de la infección bronquial por Pseudomonas aeruginosa en el paciente con fibrosis quística

Pseudomonas aeruginosa is the main pathogen in bronchopulmonary infections in cystic fibrosis (CF) patients. It can only be eradicated at early infection stages while reduction of its bacterial load is the therapeutic goal during chronic infection or exacerbations. Neonatal screening and pharmacokinetic/pharmacodynamic knowledge has modified the management of CF-patients. A culture based microbiological follow-up should be performed in patients with no infection with P. aeruginosa. At initial infection, inhaled colistin (0,5-2 MU/tid), tobramycin (300 mg/bid) or aztreonam (75 mg/tid) with or without oral ciprofloxacin (15-20 mg/kg/bid, 2-3 weeks) are recommended. In chronic infections, treatment is based on continuous administration of colistin or with a 28-day on-off regimen with tobramycin or aztreonam. During mild-moderate exacerbations oral ciprofloxacin (2-3 weeks) can be administered while serious exacerbations must be treated with intravenous combination therapy (beta-lactam with an aminoglycoside or a fluoroquinolone). Future studies will support antibiotic rotation and/or new combination therapies. Epidemiological measures are also recommended to avoid new P. aeruginosa infections and “patient-to-patient transmission” of this pathogen.     

Valoración de la influencia de la superficie de la membrana y el flujo sanguíneo en dializadores de medio cut-off

IntroductionRecently, a new class of dialyzers, medium cut-off membranes (MCO), designed to improve the permeability, which could provide an efficacy similar to hemodiafiltration, have been incorporated into our therapeutic possibilities. To increase the knowledge about its use, the objective of the study was to evaluate the effect of the surface and blood flow (Qb) on the depurative efficacy in the MCO membranes.Material and methodsWe included 19 patients in the hemodialysis. Each patient received 6 sessions, in which the membrane surface was varied, from 1.7 to 2.0 m², and/or the Qb (300, 350, 400 or 450 mL/min). In each session, different solutes were determined at the beginning and end of dialysis.ResultsThe surface change of the dialyzer did not show significant differences in the removal of small or large molecules, without changes in albumin loss. The increase in Qb was accompanied by an increase in clearance of small molecules, without showing differences in the percentage reduction of β₂-microglobulin, myoglobin, prolactin, α₁-microglobulin and α₁-acid glycoprotein, except for some comparison with Qb 450 mL/min. There were also no differences in the loss of albumin in the dialysis fluid, less than 2.5 g in all situations.ConclusionThe increase of the surface area from 1.7 to 2.0 m² in the MCO dialyzer has not meant a greater depurative effectiveness. In these dialyzers the increase of Qb does not seem to be as determinant as in hemodiafiltration except for the clearance of small molecules.     

Papel de las tecnologías de la información y la comunicación en la medicina actual

In the last few years there has been has been an explosion in information and communication technologies (ICT) both worldwide and in the health sector, mainly due to access to personal computers and internet expansion, which has facilitated access among health professionals and the public (whether patients, users, or citizens) to increasing information and communication on health. The spectrum of ICT is extremely wide and, in the last few years, has included electronic health (e-Health), defined as the set of techniques and devices used for treatment and the transmission of health information. Within e-Health, new fields are expanding, such as the electronic medical record and telemedicine.Digital medicine has transformed the traditional medical record into the electronic medical record and has shifted ways of gaining medical knowledge to searches of literature databases and new knowledge management tools, such as clinical practice guidelines or systematic reviews. Moreover, health organizations require computerization of their support processes, which has transformed these organizations. Telemedicine represents another revolutionary change by allowing off-site diagnosis and treatment, as well as education and continuing medical training (e-learning).Health professionals currently play an essential role in educating patients in the appropriate use of internet health resources. The doctor-patient relationship has become a «triadic» one, in which the computer plays an increasingly important role. ICT tend to improve patient safety but paradoxically also pose certain risks. In the next decade, there will be an unprecedented increase in health information, which will require enhanced measures to reduce the possible risks. These measures include the adoption of common standards, the development of better information systems, and greater training of users of the new ICT. Health professionals should be able to meet the challenge posed by this transformation.     

Estudio de una cohorte de paciente con fibrosis quística y Scedosporium spp.

IntroductionIn recent years an increase in the prevalence of colonization and infection by Scedosporium spp. in patients with cystic fibrosis (CF) has been observed. In this article, we study the frequency of isolation of Scedosporium spp. in an adult CF Unit, analyzing characteristics of the patients and predisposing factors.MethodsA retrospective observational study was conducted in 87 adult CF patients in whom the presence of positive culture for Scedosporium spp. was tested for a 5-year period (January 2012-July 2017). We recorded the following clinical variables: age, sex, body mass index, genotype, presence of pancreatic insufficiency, bacterial colonization, lung function, other complications, exacerbations and treatment, and the modified Bhalla score from the last high-resolution computed tomography. Results were analyzed with IBM SPSS Statistics Version 22.0 software.ResultsScedosporium spp. was isolated in 25.3% of patients. In the bivariate analysis, these patients showed a higher rate of Pseudomonas aeruginosa infection, worse score in the Bhalla classification (highlighting the following items: bronchiectasis, mucus plugs and bronchial generations), a slight decrease in the lung diffusion capacity and more frequently received inhaled antibiotics. In the logistic regression multivariate analysis, only the bronchial generations item was significant.ConclusionScedosporium spp. must be considered an emerging opportunistic pathogen in patients with CF whose clinical involvement, risk factors or need for treatment is unknown.