Experiencia con colistina nebulizada en pacientes con bronquiectasias no fibrosis quística colonizadas por Pseudomonas aeruginosa

espanolIntroduccion. La colonizacion/infeccion cronica por Pseudomonas aeruginosa de las bronquiectasias se relaciona con dano anatomico, deterioro mas rapido de la funcion pulmonar, aumento del numero de exacerbaciones y mayor morbi-mortalidad. La colistina nebulizada disminuye la carga bacteriana, esperandose una reduccion en numero y gravedad de las exacerbaciones y retraso del deterioro pulmonar. El objetivo principal fue valorar si el tratamiento con colistina nebulizada, durante al menos 6 meses, reduce el numero de ingresos y visitas a urgencias. Material y metodos. Estudio observacional, retrospectivo y no intervencionista llevado a cabo en una estructura organizativa de gestion integrada. Se seleccionaron pacientes con bronquiectasias no fibrosis quistica, mayores de 18 anos, colonizados / infectados por P. aeruginosa que recibieron al menos 6 meses colistina nebulizada. De la historia clinica informatizada (IANUS® v.04.20.0503) y de la receta electronica del SERGAS, se recogieron datos clinicos, microbiologicos y de tratamiento de los pacientes, que fueron divididos en dos periodos de tiempo: 1) 6 meses pretratamiento y durante el tratamiento y 2) 12 meses pretratamiento y durante el tratamiento, en aquellos pacientes que completaron 1 ano de tratamiento. Resultados. Se incluyeron 44 pacientes y de ellos, 29 (65,9%) tuvieron un seguimiento de 12 meses. El uso de colistina nebulizada disminuyo de forma significativa el numero de visitas a urgencias (a los 6 meses), la frecuencia y duracion de las hospitalizaciones (a los 6 y 12 meses), el consumo de antibioticos (a los 6 y 12 meses) y los cultivos positivos para P. aeruginosa. El tratamiento fue bien tolerado en casi todos los pacientes. Conclusiones. El tratamiento con colistina nebulizada durante 6 y 12 meses de bronquiectasias no fibrosis quistica, colonizadas / infectadas por P. aeruginosa, parece beneficioso para el paciente desde el punto de vista clinico y de calidad de vida y podria reducir el coste economico del proceso. EnglishIntroduction. Chronic colonisation/infection by Pseudomonas aeruginosa of the bronchiectasis is related to a faster deterioration of lung function, an increase in the number of exacerbations and a higher morbidity and mortality. Nebulised colistin decreases bacteria load. Therefore, a reduction in the number and in the severity of exacerbations and a delay of pulmonary decline is expected. The main objective is to evaluate if the treatment with nebulised colistin, for at least 6 months reduces the number of admissions and visits to the emergency department. Material and methods. Observational, retrospective and non-interventionist study carried out in an organizational structure with an integrated management. Patients with non-cystic fibrosis bronchiectasis colonised / infected by P. aeruginosa, older than 18 years, were selected. Patients must have received nebulized colistin during at least 6 months. Clinical, microbiological and therapeutic data from the patients were collected from the SERGAS computerized clinical history (IANUS® v.4.20.0503) and the electronic prescription, which were divided into two time periods: 1) 6 months pre-treatment and during the treatment and 2) 12 months pre-treatment and during the treatment, in those who completed 1 year of treatment. Results. Forty-four patients were included and of these, 29 (65.9%) had a follow-up of 12 months. The use of nebulized colistin decreased significantly the number of visits to the emergency (at 6 months), the frequency and duration of hospitalizations admissions (at 6 and 12 months), the antibiotic consumption (at 6 and 12 months) and the positive cultures. The treatment was well tolerated in almost all patients. Conclusions. The treatment with nebulised colistin during 6 and 12 months of non-cystic fibrosis bronchiectasis, colonised/infected by P. aeruginosa, seems beneficial for the patient, from the clinical and quality of life point of view, and could reduce the economic cost of the process.