Nosocomial pneumonia in immunosuppressed patients.
Nosocomial pneumonia represents a serious challenge for clinicians caring for IC patients. Although there have been advances in prophylactic, preemptive, and therapeutic measures, the implications of an inadequate empirical treatment for survival require a prompt and active attitude. A great diversity of diagnostic and laboratory procedures is currently available. In each case, the clinician must determine the tests that should be performed based on different variables. The proper use of noninvasive and bronchoscopic procedures substantially increases the diagnostic yield causing changes in the empirical treatment in most patients. The authors believe that fiberoptic bronchoscopy must be done early when the pulmonary infiltrates are identified if there is not a rapid (48 hours) and clear response to empiric treatment. This approach allows the establishment of a more specific treatment when the possibilities of full recovery are still high. The potential benefit of treatment modifications for survival in IC patients who require MV and undergo bronchoscopy is most probably minimal, because of the severity and irreversibility of the underlying pulmonary process. It is hoped that the application of molecular tools in diagnosis and the advances in preventive strategies and therapeutic agents will improve the survival of NP in a population of IC patients that is expected to grow over the next years.
Servei de Pneumologia, Institut Clinic de Pneumologia i Cirurgía Toràcica, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Seunyer, Universitat de Barcelona, Villarroel 170, 08036 Barcelona, Spain. cagusti@medicina.ub.es
Carlos
C
Agustí
Ana
A
Rañó
Oriol
O
Sibila
Antoni
A
Torres
D001999:Bronchoscopy / Q000379:methods; D003422:Critical Care / Q000379:methods*; D003428:Cross Infection / Q000175:diagnosis / Q000209:etiology* / Q000382:microbiology; D006801:Humans; D007165:Immunosuppression Therapy; D016377:Organ Transplantation; D018410:Pneumonia, Bacterial / Q000175:diagnosis / Q000209:etiology* / Q000382:microbiology; D012307:Risk Factors