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

Article information

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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Bibliografía

[1.]

Centers for Disease Control.

National Nosocomial Infections Study Report.

Annual Summary, 35 (1984), pp. 17SS-29SS

[2.]

P.A. Gross, H.C. Neu, P. Aswapokee, et al.

Deaths from nosocomial infections: Experience in a university hospital and a community hospital.

Am J Med, 68 (1980), pp. 219-223

Medline

[3.]

Grupo trabajo EPINCAT.

Prevalencia de las infecciones nosocomiales en Cataluña (I).

Infecciones y factores de riesgo. Med Clin (Barc), 95 (1990), pp. 41-52

[4.]

M. García Cenoz, J. Garcá de Jalon, R. Ibáñez Navarro, et al.

El índice ASA como indicador de riesgo de infección nosocomial en pacientes no quirúrgicos.

An Med Intern (Madrid), 12 (1995), pp. 323-328

[5.]

A. Torres, R. Aznar, J.M. Gatell, et al.

Incidence, risk, and prognosis factors of nosocomial pneumonia in mechanically ventilated patients.

Am Rev Respir Dis, 142 (1990), pp. 523-528

http://dx.doi.org/10.1164/ajrccm/142.3.523 | Medline

[6.]

J.-Y. Fagon, J. Chastre, A.J. Hence, et al.

Detection of nosocomial lung infection in ventilated patients: use of protected specimen brush and quantitative culture techniques i n 147 patients.

Am Rev Respir Dis, 138 (1988), pp. 110-116

http://dx.doi.org/10.1164/ajrccm/138.1.110 | Medline

[7.]

S.N. Abraham, E.H. Beachey, W.A. Simpon.

Adherence of Streptococcus pyogenes, Escherichia coli, and Pseudomonas aeruginosa to fibronectin-coated and uncoated ephitelial cells.

Infect Immun, 41 (1983), pp. 1261-1268

Medline

[8.]

M. Langer, M. Cigada, M. Mandell, et al.

Incidence, time of onset and mortality of nosocomial pneumonia in intensive care patients.

Réan Soins Intens Méd Urg, 6 (1990), pp. 102-103

[9.]

S. Chaudhary, W.T. Hughes, S. Feldman, et al.

Percutaneous transthoracic needle aspiration of the lung.

Am J Dis Child, 131 (1977), pp. 902-907

Medline

[10.]

J.-Y. Fagon, J. Chastre, Y. Domart, et al.

Nosocomial pneumonia in patients in receiving continuous mechanical ventilation.

Am Rev Respir Dis, 139 (1989), pp. 877-884

http://dx.doi.org/10.1164/ajrccm/139.4.877 | Medline

[11.]

J. Rello, V. Ausina, M. Ricart, et al.

Impact of previous antimicrobial therapy on the etiology and outcome of ventilator-associated pneumonia.

Chest, 104 (1993), pp. 1230-1235

Medline

[12.]

H. Leyden.

Ueber infectiose pneumoniae.

Deutsch Med Wschr, 9 (1883), pp. 52-54

[13.]

S. Chodosh.

Examination of sputum cells.

N Engl J Med, 282 (1970), pp. 854-857

http://dx.doi.org/10.1056/NEJM197004092821507 | Medline

[14.]

M.E. Burt, M.W. Fye, B.L. Weber, et al.

Prospective evaluation of aspiration needle, transbronchial, and open lung biopsy in patients with pulmonary infiltrates.

Ann Thorac Surg, 32 (1981), pp. 146-153

Medline

[15.]

J.M. Wallace, P. Batra, H. Gong Jr., et al.

Percutaneous needle lung aspiration for diagnosing pneumonitis in the patient with acquired immunodeficiency syndrome (AIDS).

Am Rev Respir Dis, 131 (1985), pp. 389-392

http://dx.doi.org/10.1164/arrd.1985.131.3.389 | Medline

[16.]

J.G. Barlett.

Diagnosis techniques for respiratory infections.

Respiratory infections: diagnosis and manegement, 2.a, pp. 55-77

[17.]

A. Torres, P. Jiménez, J. Puig de la Bellacasa, et al.

Diagnostic value of nonfluroscopic percutaneus lung needle aspiration in patiens with pneumonia.

Chest, 98 (1990), pp. 840-844

Medline

[18.]

R. Zalacaín, L. Llorente, L. Gaztelurrutia, et al.

La punción transtorácica aspirativa con aguja ultrafina en las neumonías de alto riesgo adquiridas en la comunidad.

Med Clin (Barc), 100 (1993), pp. 567-570

[19.]

K.M. Moser, J. Maurer, L. Jassy, et al.

Sensitivity, specificity, and risk of diagnostic procdures in a canine model of Streptococcus pneumoniae pneumonia.

Am Rev Respir Dis, 125 (1982), pp. 436-442

http://dx.doi.org/10.1164/arrd.1982.125.4.436 | Medline

[20.]

J. Samper, J. Martínez López de Letona, et al.

Utilidad de la punción aspirativa pulmonar con aguja fina en procesos infecciosos y malignos.

Med Clin (Barc), 81 (1983), pp. 1-3

[21.]

J. Dorca, F. Manresa, L.L. Esteban, et al.

Efficacy, Safety, and therapeutic relevance of transthoracic aspiration with ultrathin needle in non ventilated nosocomial pneumonia.

Am J Respir Crit Care, 151 (1995), pp. 1491-1496

[22.]

M.A.G. Ariza, J.T. Nuez, E.R.A. Aguiran, et al.

Complicaciones y riesgo de la punción aspirativa transtorácica.

Estudio de 873 pacientes y revisión de la literatura. Arch Bronconeumol, 26 (1990), pp. 186-191

[23.]

R. Celis, A. Torres, J.M. Gatell, et al.

Nosocomial pneumonia: A multivariate analisis of risk and prognosis.

Chest, 93 (1988), pp. 318-324

Medline

[24.]

J.G. Barlett, P. O’Keefe, F.P. Tally, et al.

Bacteriology of hospital-acquired pneumonia.

Arch Intern Med, 146 (1986), pp. 868-871

Medline

[25.]

D.J. Weber, R. Raasch, W.A. Rutala.

Nosocomial Infections in the ICU.

The Growing Importance of antibiotic-Resistant Pathogens. Chest, 115 (1999), pp. 34S-41S

[26.]

M.J. Richards, J.R. Edwards, D.H. Culver, et al.

Nosocomials Infections in medical intensive care units in the United States.

Crit Care Med, 27 (1999), pp. 887-892

Medline

[27.]

M. Caseta, F. Bot, S. Antoun, et al.

Diagnosis of nosocomial pneumonia in cancer patients undergoing mechanical ventilation. A prospective comparison of plugged telescoping catheter with the protected specimen brush.

Chest, 115 (1999), pp. 1641-1645

Medline

[28.]

C.M. Luna, P. Vujacich, M.S. Niederman, et al.

Impact of BAL data on the therapy and outcome of ventilator-associatyed pneumonia.

Chest, 111 (1997), pp. 676-685

Medline

[29.]

T.C. Horan, J.W. White, W.R. Jarvis, et al.

Nosocomial infection surveillance 1984.

MMWR CDC Surreill Summ, 35 (1986), pp. 17SS-29SS

[30.]

Sociedad Española de Higiene, Medicina Preventiva Hospitalaria.

Prevalencia de las infecciones nosocomiales en los hospitales españoles.

Proyecto EPINE 1991, Soc Esp Hig Med Prev Hosp, (1992),

[31.]

J.Y. Fagon, J. Chastre, Y. Domart, et al.

Nosocomial pneumonia in patients receiving continuous mechanical ventilation: perspective analysis of 52 episodes with use of protected specimenbrush and quantitative culture techniques.

Am Rev Respir Dis, 139 (1989), pp. 877-884

http://dx.doi.org/10.1164/ajrccm/139.4.877 | Medline

[32.]

C.V. Broome, S.A.J. Goings, S.B. Thacker, et al.

The Vermont epidemic of Legionaires’disease.

Ann Intern Med, 90 (1979), pp. 573-577

Medline

[33.]

C.H.E. Haley, M.L. Cohen, J. Halter, et al.

Nosocomial Legionaires’ disease: a continuing common-source epidemic at Wadsworth Medical Center.

Ann Intern Med, 90 (1979), pp. 583-596

Medline