medigraphic.com
ISSN 1684-1824 (Electronic)

2012, Number 3

<< Back Next >>

Rev Méd Electrón 2012; 34 (3)

Community-acquired pneumonia: clinic-epidemiological characterization

Rosa RZ, Hernández PM

Language: Spanish
References: 28
Page:
PDF size: 185.49 Kb.


ABSTRACT

Introduction: the community-acquired pneumonia is the most frequent cause of death of infectious etiology in the developed countries in the XXI century. It has a high incidence and morbimortality, situation that is worsened by the emergency of communitarian multi resistant germs. The severity prognostic scales are useful tools in the therapeutic- diagnostic confrontation of this disease. Based on that, the authors proposed themselves the objective of characterizing the clinic-epidemiologic behavior of the community-acquired pneumonia, linking it with the CRB-65 scale application.
Methods: descriptive, observational and prospective research on the universe of patients who entered the Teaching Surgical Clinical Hospital Comandante Faustino Perez, of Matanzas, in 2007, for community-acquired pneumonia. We used dialectic-materialist philosophic, empiric, theoretic and statistic methods with variables selection and operationalization, applying summarizing measures.
Results: near 50 % of the patient who assisted the hospital with community-acquired pneumonia were admitted as in-patients, 74,7 % of them were elder than 65 years old; the combined antimicrobial therapy reached 44 %. When the CRB-5 scale was applied more than 60 % had scarce predicted severity; among those who had values predicting severity, 60 % were transferred late to health care units for seriously ill persons. The total mortality was 4,2 %, and 40 % in the health care units for seriously ill persons.
Conclusions: community-acquired pneumonia had a high incidence and was the cause of a frequent hospitalization, mainly in the geriatric population, with associated co-morbidities. In a high proportion the hospitalization was decided in groups of scarce severity, needed of an ambulatory treatment according to the prognostic scale CRB-65; from the other hand there were cases with seriousness criteria transferred late to the health care units for seriously ill persons.


REFERENCES

  1. Pedro-Pons A, Farreras Valentí P, Foz Tena A. Tratado de Patología y Clínicas Médicas. La Habana: Editorial Ciencia y Técnica; 1969.

  2. Feikin DR, Schuchat A, Kolczak M, Barrett NL, Harrison LH ,Leftwoitz l, et al. Mortality from invasive pneumococcal pneumonia in the era of antibiotic resistance, 1995–1997. Am J Public Health. 2000;90:223-9. PubMed; PMID: 10667183.

  3. García Satué JL, Aspa Marco J. Neumonías. En: Monografías NEUMOMADRID. Madrid: Ed. ERGON; 2005, vol. IX.

  4. Butt S, Swiatlo E. Treatment of community-acquired pneumonia in an ambulatory setting. Am J Med. 2011 Apr;124(4):297-300. PubMed; PMID: 21435417.

  5. Centers for Disease control and Prevention [Internet]. Atlanta, GA: Centers for Disease control and Prevention;[actualizado 23 Ene 2012; citado 15 Feb 2012]. National Center for Health Statistics; [aprox. 2 pantallas]. Disponible en: http://www.cdc.gov/nchs/index.htm.

  6. Laterre PF. Severe community acquired pneumonia update: mortality, mechanisms and medical intervention. Critical Care.2008;12(Suppl 6): S1. PubMed; PMID: 19105794.

  7. Roca Goderich R, Smith Smith V, Paz Presilla E, Losada Gómez J, Serret Rodríguez B, Lamos Sierra N, et al. Temas de Medicina Interna. t. 3. La Habana: Editorial Ciencias Médicas; 2002.

  8. Dirección Nacional de Registros Médicos y Estadística. Anuario Estadístico de Salud Pública 2006. La Habana: Ministerio de Salud Pública; 2007.

  9. Centers for Disease control and Prevention [Internet]. Atlanta, GA: Centers for Disease control and Prevention; [actualizado 23 Feb 2010; citado 1 Mar 2010]. Preventing seasonal flu with vaccination. Disponible en: http://www.cdc.gov/flu/protect/preventing.htm.

  10. Jackson ML, Neuzil KM, Thompson WW, Shay DK, Yu O, Hanson CA, et al. The burden of community-acquired pneumonia in seniors: results of a population-based study. Clin Infect Dis. 2004; 39:1642–50. PubMed; PMID: 15578365.

  11. Rello J. Review Demographics, guidelines, and clinical experience in severe community-acquired pneumonia. Critical Care. 2008;12(Suppl 6):S2. PubMed; PMID: 19105795.

  12. Carratalà J, Fernández-Sabé N, Ortega L, Castellsagué X, Rosón B, Dorca J, et al. Outpatient Care Compared with Hospitalization for Community-Acquired Pneumonia: A Randomized Trial in Low-Risk Patients. Ann Intern Med [Internet]. 2005 Feb [citado 15 Feb 2012]; 142:165-72. Disponible en: http://www.annals.org/content/142/3/165.short

  13. Lim WS. Severity assessment in community acquired pneumonia: moving on. Thorax. 2007; 62(4):287-8. PubMed; PMID: 17387212.

  14. Buising KL, Thursky KA, Black JF. A prospective comparison of severity scores for identifying patients with severe community acquired pneumonia: reconsidering what is meant by severe pneumonia. Thorax. 2006;61(5):419-24. PubMed; PMID: 16449258.

  15. España PP, Capelastegui A, Gorordo I, Esteban C, Oribe M, Ortega M, et al. Development and validation of a clinical prediction rule for severe community-acquired pneumonia. Am J Respir Crit Care Med. 2006;174(11):1249-56. PubMed; PMID: 16973986.

  16. Fang WF, Yang KY, Wu CL, Yu CJ, Chen CW, Tu CY, et al. Application and comparison of scoring indices to predict outcomes in patients with healthcare-associated pneumonia. Crit Care. 2011;15(1):R32. PubMed; PMID: 21247444.

  17. File TM, Jr. The CMS Core (Performance) Measures for Community-Acquired Pneumonia (CAP): Relating to Antimicrobial Stewardship Posted: 11/18/2010. Disponible en: http://www.medscape.org/viewarticle/

  18. File TM, Jr. Community-Acquired Pneumonia: Mild Illness or Serious Disease? Medscape Education Infectious Diseases [citado 23 Jun 2011]. Disponible en: http://www.medscape.org/viewarticle/744667

  19. Osler W. The principles and practice of medicine. 4th ed. New York: D Appleton; 1990.

  20. Lovesio C. Medicina Intensiva. 5ta ed. Buenos Aires: Editorial El Ateneo; 2007.

  21. Álvarez Martínez CJ. Neumonías: concepto, clasificación y diagnóstico diferencial. En: Monografías NEUMOMADRID. Madrid: Ed. ERGON; 2005; vol. IX.

  22. Mandell LA, Wunderink RG, Anzueto A. Bartlett JG, Campbell GD, Dean NC, et al. IDSA/ATS Consensus Guidelines on the Management of Community-Acquired Pneumonia. CID. 2007;44(Suppl 2):S27-72.

  23. Organización Panamericana de la Salud. Guía para el tratamiento de las enfermedades infecciosas. Washington, DC: OPS; 2004.

  24. Macfarlane JT, Boldy D. 2004 update of BTS pneumonia guidelines: what’s new? Thorax. 2004;59(5):364-6. PubMed; PMID: 15115857.

  25. Barclay L. Direct Transfer to ICU May Benefit Some Patients Without Major Criteria for Severe Community-Acquired Pneumonia. Crit Care Med. 2009;37(11):2867-74.

  26. National Institute for Health and Clinical Excellence. Prescribing of Antibiotics for Self-limiting Respiratory Tract Infections in Adults and Children in Primary Care. London: National Institute for Health and Clinical Excellence; 2008.

  27. Capelastegui A, España PP, Quintana JM, Gorordo I, Ortega M, Idoiaga I, et al. Improvement of process-of-care and outcomes after implementing a guideline for the management of community-acquired pneumonia: a controlled before-and-after design study. Clin Infect Dis 2004; 39(7):955-63. PubMed; PMID: 15472846.

  28. Fine MJ, Stone RA, Singer DE, Coley CM, Marrie TJ, Lave JR, et al. Processes and outcomes of care for patients with community acquired pneumonia: results from the Pneumonia Patient Outcomes Research Team (PORT)cohort study. Archives of Internal Medicine 1999; 159(9):970-80. PubMed; PMID: 10326939.




2020     |     www.medigraphic.com