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Diferencias microbiológicas en pacientes con exacerbación severa de EPOC con o sin consolidación neumónica

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dc.contributor.advisorAguirre Franco, Carlos Eduardo
dc.contributor.advisorBeltrán Rodríguez, Johnny Adalber
dc.creatorTorres Caro, Maria Cristina
dc.creator.degreeEspecialista en Medicina Interna
dc.date.accessioned2013-02-04T22:23:21Z
dc.date.available2013-02-04T22:23:21Z
dc.date.created2012-12-03
dc.date.issued2012
dc.descriptionLa EPOC es una causa importante de morbilidad y mortalidad en el mundo y su prevalencia en Bogotá alcanza hasta 8,5%. Las exacerbaciones están asociadas a deterioro funcional y de la calidad de vida por lo que se consideran un factor cardinal de la enfermedad. En la literatura se ha descrito que las infecciones por bacterias y/o virus son las responsables del 78% de las exacerbaciones. Estos datos han sido descritos en poblaciones diferentes y no hay datos en la literatura que muestren cual es la epidemiología local de las exacerbaciones de EPOC y menos aún de aquellas que se asocian a consolidaciones neumónicas. Objetivo: Comparar la microbiología de las exacerbaciones severas de la EPOC que requieren ingreso a UCI con y sin infiltrados alveolares. Materiales y métodos: Estudio de corte transversal en el que se estudiaron pacientes con EPOC que ingresaron a la UCI Médica de la FCI-IC por exacerbación severa, asociada o no a infiltrados alveolares. Se tomaron muestras de microbiología, serológicas y radiografía de tórax para evaluar la etiología de la exacerbación, si se asocia a coinfección viral y a consolidación neumónica o no. Resultados: No se encontró una diferencia estadísticamente significativa en la microbiología de los diferentes grupos evaluados. Se encontró un resistencia global del 24% y llama la atención que hay una alta prevalencia de Serratia Marcescens AMPc entre los 2 grupos, germen que no está descrito como patógeno común en la literatura. Se encontraron diferencias en cuanto a factores de riesgo para presentar neumonía asociada como lo son un mayor índice de paquetes/año (55.1.6 vs. 36.3 paq/año, sig.=0.021). Así mismo se demostró que los pacientes con neumonía asociada presentan mayor necesidad de IOT (48.9 vs. 23.9, sig.=0.013). No hay diferencia significativa en desenlaces como mortalidad (20.5 vs. 13.0, sig.=0.346). Conclusiones: A pesar de no haber diferencia microbiológica entre los 2 grupos se encontraron variables como factores de riesgo y variables clínicas que pueden ayudar a proponer planes de manejo en los dos escenarios. El hecho de encontrar un paciente con neumonía asociada al cuadro de exacerbación no debe afectar en la toma de decisiones en relación al tratamiento antibiótico.spa
dc.description.abstractCOPD is an important cause of morbidity and mortality around the world and it's prevalence in Bogotá rises up to 8,5%. Acute exacerbations affect functionality and life quality and therefore are considerated a cardinal factor in the disease. It has been described in the literature that bacteria and virus account for 78% of the exacerbations. However it is important to remark that these observations have been described in different populations, and there are no available data that show the local epidemiology of COPD exacerbations and also not from the ones associated with a pneumonic consolidation. Objective: To describe the microbiology from COPD severe exacerbations which require admission to the ICU with and without pneumonic consolidation. Materials and methods: We did a cross sectional study in which the population were patients diagnosed with COPD admitted to the ICU from FCI-IC because of a severe exacerbation associated or not with a pneumonic consolidation. We took microbiologic and serologic sample to study the etiology of the exacerbation and a thorax radiography to see if it was associated or not with pneumonia. Results: We did not found a difference that was statistically significative between the two evaluated groups. However we found a global bacterial resistance of 24% and an important prevalence of Serratia marcescens AMPc between the groups, which is not described as a common pathogen in the literature. We found differences in risk factors in the patients who had pneumonia such as a higher tobacco index (55.1.6 vs. 36.3 pack/ year, sig.=0.021). We also found that patients with associated pneumonia needed more ventilatory support with ventilation (48.9 vs. 23.9, sig.=0.013), and that there were no difference in mortality between the 2 groups (20.5 vs. 13.0, sig.=0.346). Conclusions: Even tough we did not found a significant difference in the microbiology from the two studied groups there are variables as risk factors and clinical variants of presentation that could help propose a therapy plan in the different scenarios of the disease. There should not be changes in the antibiotic therapy depending on associated pneumonia.eng
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dc.identifier.doihttps://doi.org/10.48713/10336_4180
dc.identifier.urihttp://repository.urosario.edu.co/handle/10336/4180
dc.language.isospa
dc.publisherUniversidad del Rosariospa
dc.publisher.departmentFacultad de Medicinaspa
dc.publisher.programEspecialización en Medicina Internaspa
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dc.source.instnameinstname:Universidad del Rosariospa
dc.source.reponamereponame:Repositorio Institucional EdocURspa
dc.subjectEPOCspa
dc.subjectNeumoníaspa
dc.subjectMicrobiologiaspa
dc.subjectEpidemiologíaspa
dc.subject.keywordCOPDeng
dc.subject.keywordPneumoniaeng
dc.subject.keywordMicrobiologyeng
dc.subject.keywordEpidemiologyeng
dc.subject.lembEnfermedad pulmonar obstructiva crónica (Epoc)spa
dc.subject.lembEnfermedades obstructivas de los pulmonesspa
dc.subject.lembEnfermedades respiratoriasspa
dc.subject.lembNeumoníaspa
dc.titleDiferencias microbiológicas en pacientes con exacerbación severa de EPOC con o sin consolidación neumónicaspa
dc.typemasterThesiseng
dc.type.hasVersioninfo:eu-repo/semantics/acceptedVersion
dc.type.spaTrabajo de gradospa
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