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Vol. 33. Issue 1.
Pages 16-19 (January 1997)
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Vol. 33. Issue 1.
Pages 16-19 (January 1997)
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El cepillado protegido bacteriológico en pacientes con EPOC severa
The protected specimen brush technique in patients with severe chronic obstructive pulmonary disease
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R. Zalacain1, V. Achótegui, I. Pascal, J. Camino, V. Sobradillo
Servicios de Neumología, Hospital de Cruces. Vizcaya
J. Barrón*
* Servicios de Microbiología. Hospital de Cruces. Vizcaya
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El objetivo de este estudio ha sido conocer mediante el empleo de una técnica de alta Habilidad cómo es el catéter teleescopado con cepillado bacteriológico (CT), la presencia de gérmenes y su concentración en un grupo de pacientes con EPOC severa (FEV1 < 50%), unos en fase de estabilización clínica y otros con datos clínicos de agudización.

Se incluyeron 26 pacientes con EPOC severa, 14 estables y 12 agudizados. Ninguno había recibido tratamiento previo con antibióticos o corticoides. Los estables no tenían ningún dato clínico de exacerbación y los agudizados tenían aumento de disnea, del volumen del esputo y de la purulencia del mismo. El CT se realizó con anestesia en aerosol, sin emplear anestesia líquida. Se consideró el CT positivo cuando había ≥ 103 UFC/ml.

No hubo diferencias entre los grupos en cuanto a edad, sexo, proporción de fumadores y ex fumadores, y paquetes/ año. En los valores espirométricos tampoco hubo diferencias salvo en la relación FEV1/CVF que fue menor en los agudizados (p<0,05). El CT fue positivo en el 57,1% de los estables y en el 66,7% de los agudizados (p=NS). H. influenwe fue el microorganismo hallado en mayor número en ambos grupos. El número medio de UFC/ml fue de 8.625 en los estables y 17.375 en los agudizados (p=NS).

Un elevado número de pacientes (57,1%) con EPOC severa en fase de estabilización clínica presentaron gérmenes en concentraciones significativas mediante el empleo de CT. Por otro lado, con esta misma técnica, en otro grupo de pacientes con EPOC severa, de similares características, pero con datos clínicos de agudización, se hallaron gérmenes en el 66,7% no siendo la diferencia significativa, y se confirmó la falta de correlación clínico-bacteriológica.

Palabras clave:
Enfermedad pulmonar obstructiva crónica (EPOC)
Cepillado protegido

To determine the presence of germs and their concentratfon in a group of patients with severe chronic obstructive pulmonary disease (COPD) (FEV1 < 50%), some of whom were in stable condition and others of whom were in acute phase.

Twenty-six patients with severe COPD (14 stable and 12 acute phase) were enrolled. None had received prior antibiotic or corticoid treatment. The stable patients had no signs or symptoms of exacerbation, whereas the acute-phase patients had increased dyspnea, sputum volume and purulence. The patients received aerosol rather than liquid anesthesia when PSB sampling was performed. A PSB fínding was considered positive at a level ≥ 103CFU/ml.

There were no significant differences between the groups with respect to age, sex, proportion of smokers and ex-smokers or packs per year. The oniy spirometric measure that was significantly different was (FEV1/FVC, which was lower in the acute-phase group (p<0.05). Positive PSB findings were recorded for 57.1% of the stable patients and for 66.7% of the acute-phase patients (p=NS). H.influenzae was the microorganism found most often in both groups. The mean CFU/ml level was 8,625 in stable patients and 17,375 in acute-phase patients (p=NS).

A large proportion of stable patients (57.1%) with severe COPD harbor significant concentrations of germs as revealed by PSB sampling. Germ concentrations were found in a non significantly greater number of acute-phase patients, confirming the lack of congruence between clinical status and bacteriological condition.

Key words:
Chronic obstructive pulmonary disease (COPD)
Protected specimen brush
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Bibliografía
[1.]
T.F. Murphy, S. Sethi.
Bacterial infection in chronic obstructive pulmonary disease.
Am Rev Respir Dis, 146 (1992), pp. 1.067-1.083
[2.]
I. Tager, F.E. Speizer.
Role of infection in chronic bronchitis.
N Engl J Med, 292 (1975), pp. 563-571
[3.]
S. Chodosh.
Acute bacterial exacerbations bronchitis and asthma.
Am J Med, 82 (1987), pp. 154-163
[4.]
J.Y. Fagon, J. Chastre, J.L. Trovillet, Y. Domart, M.C. Dombret, M. Bornet, et al.
Characterization of distal bronchial microflora during acute exacerbation of chronic bronchitis.
Am Rev Respir Dis, 142 (1990), pp. 1.004-1.008
[5.]
E. Monsó, J. Ruiz, A. Rosell, J. Manterola, J. Fiz, J. Morera, et al.
Bacterial infection in chronic obstructive pulmonary disease. A study of stable and exacerbated outpatients using the protected specimen brush.
Am J Respir Crit Care Med, 152 (1995), pp. 1.316-1.320
[6.]
L.B. Palmer.
Bacterial colonization. Pathogenesis and clinical significance.
Clin Chest Med, 8 (1987), pp. 455-467
[7.]
J.A. Martínez, J. Buges, E. Rodríguez.
La infección bronquial y su tratamiento en la enfermedad pulmonar obstructiva crónica.
Arch Bronconeumol, 8 (1992), pp. 247-252
[8.]
J.S. Elborn, D.J. Shale.
Infections of the airways.
Curr Opin Infect Dis, 5 (1992), pp. 170-175
[9.]
P. Ball.
Epidemiology and treatment of chronic bronchitis and its exacerbations.
Chest, 108 (1995), pp. 43-52
[10.]
P. Cole, R. Wilson.
Host-microbial interrelationships in respiratory infection.
Chest, 95 (1989), pp. 217-221
[11.]
C.B. Smith, C.A. Golden, R.E. Kanner, A.D. Renzetti.
Haemophilus influenzae and Hemophilus parainfluenzae in chronic obstructive pulmonary disease.
Lancet, 1 (1976), pp. 1.253-1.255
[12.]
N.J. Gross.
Chronic obstructive pulmonary disease. Current concepts and therapeutic approaches.
Chest, 97 (1990), pp. 19-23
[13.]
R.S. Irwin, A.D. Erickson, M.R. Pratter, W.M. Corrao, F.L. Garrity, J.R. Myers, et al.
Prediction of tracheobronchial colonization in current cigarette smokers with chronic obstructive bronchitis.
J Infect Dis, 145 (1982), pp. 234-241
[14.]
M. Bjerkestrand, A. Digranes, A. Schreiner.
Bacteriological findings in transtracheal aspirates from patients with chronic bronchitis and bronchiectasis.
Scand J Respir Dis, 56 (1975), pp. 201-207
[15.]
N.W. Wimberley, J.B. Bass, B.W. Boyd, M.B. Kirkpatrick, R.A. Serio, H.M. Pollock.
Use of a bronchoscopic protected catheter brush for the diagnosis of pulmonary infections.
Chest, 81 (1982), pp. 556-562
[16.]
A. Torres, R. Celis, A. Xaubet, J. Puig de la Bellacasa, C. Agustí, J. González, et al.
Distal airway flora colonizing populations of risk.
Am Rev Respir Dis, 145 (1992), pp. 543
[17.]
L. Vereen, L.M. Smart, R.B. George.
Antibody coating and quantitative cultures of bacteria in sputum and bronchial brush specimens from patients with stable chronic bronchitis.
Chest, 90 (1986), pp. 534-536
[18.]
J.A. Martínez, E. Rodríguez, T. Bastida, J. Bugés, M. Torres.
Quantitative study of the bronchial bacterial flora in acute exacerbations of chronic bronchitis.
Chest, 105 (1994), pp. 976
[19.]
American Thoracic Society.
Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease (COPD) and asthma.
Am Rev Respir Dis, 136 (1987), pp. 225-244
[20.]
N.R. Anthonisen, J. Manfreda, C.P.W. Warren, E.S. Hershfield, G.K.M. Harding, N.A. Nelson.
Antibiotic therapy in exacerbations of chronic obstructive pulmonary disease.
Ann Intern Med, 106 (1987), pp. 196-204
[21.]
R. Wilson.
Outcome predictors in bronchitis.
Chest, 108 (1995), pp. 53-57
[22.]
F.L. Sachs.
Chronic bronchitis.
Respiratory infections: diagnosis and management, pp. 142-158
[23.]
R.S. Irwin, W.M. Corrao, A.D. Erickson, M.R. Pratter, F.L. Garrity, J.T. Kaemmerlen.
Characterization by transtracheal aspiration of the tracheobronchial microflora during acute exacerbations of chronic obstructive bronchitis.
Am Rev Respir Dis, 121 (1980), pp. 150
[24.]
M.R. Nicotra, M. Rivera.
Chronic bronchitis: when and how to treat.
Semin Respir Infect, 3 (1988), pp. 61-71
[25.]
H. Haas, J.F. Morris, S. Samson, J.P. Kilboum, J. Kim.
Bacterial flora of the respiratory tract in chronic bronchitis: comparison of transtracheal, fiberbronchoscopic and oropharyngeal sampling methods.
Am Rev Respir Dis, 116 (1977), pp. 41-47
[26.]
T.J. Marrie, H. Durant, L. Yates.
Community-acquired pneumonia requiring hospitalization: 5-year prospective study.
Rev Infect Dis, 11 (1989), pp. 586-599
[27.]
A.P.E. Sachs, G.H. Koeter, K.H. Groenier, D. Van der Waaij, J. Schiphuis, B. Meyboom de Jong.
Changes in symptoms, peak expiratory flow, and sputum flora during treatment with antibiotics of exacerbations in patients with chronic obstructive pulmonary disease in general practice.
Thorax, 50 (1995), pp. 758-763
[28.]
H.M. Jansen, A.P.E. Sachs, L. Van Alphen.
Predisponing conditions to bacterial infections in chronic obstructive pulmonary disease.
Am J Respir Crit Care Med, 151 (1995), pp. 2.073-2.080
Copyright © 1997. Sociedad Española de Neumología y Cirugía Torácica
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