Valor de la punción transtorácica aspirativa en el diagnóstico etiológico de la neumonía nosocomial de los pacientes no ingresados en UCI

Nicolás Sánchez, F.J.; Vilá Justribó, M.; Merino Laborda, M.T.; Rubio Caballero, M.

doi:10.1016/S0300-2896(15)30122-8

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El objetivo de este estudio fue conocer el diagnóstico etiológico de la neumonía nosocomial en pacientes no ingresados en la UCI. Se realizó de forma prospectiva en el Hospital Universitario Arnau de Vilanova de Lleida durante el tiempo comprendido entre el 1 de mayo de 1994 hasta el 28 de febrero de 1996, diagnosticándose 103 casos. Se empleó la punción transtorácica aspirativa por considerarla el método más útil, dada la alta especificidad y la baja complejidad de la técnica. Se practicó punción transtorácica aspirativa en 67 casos, siendo positiva en 10 ocasiones (14,9%). El cultivo de esputo se recogió en 62, considerándose verdadero positivo en seis (9,7%), el cultivo de líquido pleural se realizó en 35 ocasiones, y fueron aislados gérmenes en 2 casos (5,7%), y el cepillado bronquial con catéter telescopado se practicó en 4 pacientes, dando resultado positivo en otros dos. Se tomaron muestras para serología en 51 casos, siendo diagnóstico en cuatro (7,8%). Los gérmenes más frecuentes fueron Pseudomonas aeruginosa (13,3%), Staphylococcus aureus (13,3%), Chlamydia pneumoniae (10%) y Legionella pneumophila (10%). Objetivamos etiología polimicrobiana en el 33,3% de los casos. Sólo se encontraron como complicaciones neumotórax en 2 casos (3%), de los que uno precisó drenaje. Podemos concluir en que la punción transtorácica aspirativa, técnica de alta especificidad, constituye un procedimiento útil en el diagnóstico de la neumonía nosocomial en pacientes no sometidos a ventilación mecánica, evidenciando además una muy baja tasa de complicaciones.

Palabras clave:

Neumonía

Nosocomial

Punción transtorácica aspiratoria

The aim of this study was to determine the etiologic diagnosis of nosocomial pneumonia in hospitalized patients outside the intensive care unit. The study was carried out prospectively at the University Hospital Arnau de Vilanova in Lerida (Spain) from 1 May 1994 through 28 February 1996, during which 103 cases were diagnosed. Transthoracic needle aspiration (TNA) was chosen as the most useful diagnostic procedure, given its high specificity and low rate of complications. Sixty-seven TNA procedures were carried out; 10 (14.9%) were positive. Sputum was cultured for 62 patients and true positives were observed in 6 (9.7%). Pleural liquid was cultured for 35 patients and germs were isolated for 2 (5.7%). Bronchial brushing with a telescoping catheter was performed in 4 patients and brush culture provided 2 additional positives. Blood samples from 51 patients were cultured provided 4 additional diagnoses (7.8%). The most commonly found germs were P. aeruginosa (13.33%), S. aureus (13.3%), C. pneumoniae (10%) and L. pneumophila (10%). Disease was polymicrobial in 33.3%. Complications were observed, in the form of pneumothorax, in 2 cases (3%), one of which required drainage. We conclude that TNA, which is highly specific and has a low rate of complication, is a useful procedure for diagnosing nosocomial pneumonia in patients who are not being mechanically ventilated.

Key words:

Neumonia

Nosocomial

Transthoracic needle aspiration

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