In our study population, the routine use of quantitative invasive diagnostic tools is not justified in the setting of ventilated patients clinically suspected of having nosocomial pneumonia.

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Background:Nosocomial pneumonia (NP) is a common complication in mechanically-ventilated patients and is considered to be one of the most common causes of morbidity and mortality. However, assessment of the associated mortality is not staightforward as it shares several risk factors with NP that confound the relationship. The aim of this study was to evaluate the impact of NP on the mortality rate in an intensive care unit. During the study period (January-December 1995) all patients under mechanical ventilation for a period > 48 h (n = 314) were prospectively evaluated, and the prognostic factors of NP, which have been identified in previous studies, were recorded.Results:Pneumonia was diagnosed in 82 patients. The overall mortality rate was 34% for patients with NP compared to 17% in those without NP. Multivariate analysis selected the following three prognostic factors as being significantly associated with a higher risk of death: the presence of multiple organ failure [odds ratio (OR) 6.71, 95% CI, P < 0.001]; the presence of adult respiratory distress syndrome (ARDS) (OR 3.03, 95% CI, P < 0.01), and simplified acute physiology score (SAPS)> 9(OR 2.89, 95% CI, P < 0.05).Conclusions:In mechanically-ventilated patients NP does not represent an independent risk factor for mortality. Markers of severity of illness were the strongest predictors for mortality.

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erythema, desquamation area and outflow of crystal liquid without smell through the fistula, denies weight loss and fever, mobility limitation and pain with moderate intensity, so attends orthopedist, requested image studies and chronic granulomatous inflammatory reaction is reported by biopsy, necrosis area with multinucleate cells sourrading capsule's sporangium with endospores, characteristic of Coccidioides spp. Started with B amphotericin lipid complex with good evolution, change to itraconazole 400 mgs orally, currently his progress getting better.Results: Discussion Every time they are more reports of infections caused by Coccidioides spp in the literature. The joints are frequently sites of dissemination. The real incidence is unknown in Mexico. It is very important to suspect it since the infection can occur at any age, so this way it can have an impact on the prognostic and decrease the complications. The demonstration of the pathogen is still the gold standard.Conclusion: Invasive fungal infections are a significant cause of morbidity and mortality, the successful of the treatment involves an early diagnosis, and we propose the boarding of chronic injuries with this characteristics.