Martínez-Hernández L, Vilar-Compte D, Cornejo-Juárez P, Volkow-Fernández P

Idioma: Español
Referencias bibliográficas: 29
Paginas: 465-472
Archivo PDF: 778.70 Kb.

RESUMEN

Introducción: La neumonía nosocomial en pacientes con NH tiene una mortalidad hasta del 90%. Existen pocos estudios que reporten la incidencia de NN en pacientes con NH. Objetivo: Describir la epidemiología y curso clínico de la NN en una cohorte de pacientes hemato-oncológicos. Material y métodos: Estudio retrospectivo, en pacientes con NH y NN de enero de 2011 a diciembre de 2012. Resultados: Se documentaron 105 NN, 51 leucemias (48%) y 45 linfomas (43%); 50 (48%) en recaída o progresión. La mediana de días para desarrollo de NN fue de 13 (IQ 6-20). El 60% tenía neutropenia grave. El síntoma más frecuente fue fiebre en 73 (70%). El 100% tenía infiltrados por tomografía, en 45 (43%) sugestivos de infección fúngica. Siete (7%) tuvieron micosis pulmonar invasiva comprobada, posible 9 (9%) y probable 45 (43%). Se tomaron 99 cultivos; 30 (67%) de los hemocultivos fueron positivos, y 31 (71%) de los cultivos de expectoración. El 60% de las bacterias gramnegativas y 50% de las grampositivas fueron multirresistentes. El principal germen aislado fue E. coli, 19 (30%). Aspergillus spp ocupó el tercer lugar como agente causal y tuvo la mayor mortalidad. La mortalidad atribuible fue de 50%, y del 73% en pacientes con ventilación mecánica (VM) (p = 0.001). Conclusiones: Observamos una alta mortalidad en pacientes con NH y NN. Se requiere incrementar la sospecha clínica de NN en pacientes que reciben quimioterapia mielotóxica, establecer un abordaje diagnóstico microbiológico estandarizado, tomografía computarizada (TC) de tórax e introducir nuevas técnicas diagnósticas.

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