Gonzaga-López TI, Salgado-Muñoz TG, Morones-Esquivel I, Matamoros-Mejía AP, Terán-González JO, Arteaga-Vázquez S, Castro-D’Franchis LJ, Reyes-Jiménez AE, Mijangos-Huesca FJ

Language: Spanish
References: 22
Page: 271-276
PDF size: 672.29 Kb.

ABSTRACT

Background: Bacterial pneumonia is an infection caused by microorganisms acquired in the outpatient setting. It represents a healthcare problem in Mexico and all over the world. It may be caused mainly by Streptococcus pneumoniae (21-39%), Haemophilus influenzae (1.5- 14%) and Staphylococcus aureus (0.8-9%) in ambulatory patients, and in hospitalized patients by S. pneumoniae, Mycoplasma pneumoniae and Chlamydophila pneumoniae.
Objetive: To establish if there is a difference among pathogens that cause community-acquired pneumonia in the Hospital Central Norte, PEMEX, that were treated according to the IDSA guidelines (Infectious Diseases Society of America), as well as its antibiotic resistance.
Material and Method: An observational, descriptive, transversal and retrospective study was made with 249 patients (probabilistic sample) from January 2013 to May 2015.
Results: We obtained 112 sputum cultures with the isolation of: Pseudomonas aeruginosa 25%, Escherichia coli 23% and Klebsiella pneumoniae 12.5%. When we compared our results with the international statistics (IDSA), it only matched on 0.8%. The empiric treatment based on those guidelines (ceftriaxone + clarithromycin-azithromycin or levofloxacin) reported a microbial resistance of 92% and 67% of Pseudomonas aeruginosa, 73% of Escherichia coli and 67% and 83% of Klebsiella pneumoniae, respectively.
Conclusion: Community-acquired pneumonia is among the fifth main causes of morbidity and mortality in the PEMEX Hospital with predominance of gram-negative bacteria. Microorganisms have better sensitivity to aminoglycosides, cefepime, piperacillin, tazobactam and carbapenemics. We remark the importance of obtaining reliable cultures and creating local guidelines in every healthcare unit in order to diminish bacterial resistance, healthcare related complications, hospital stay length, readmissions and improve treatment outcomes.

REFERENCES

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6. Lim W, Baudouin S, George R, Hill A, et al. British Thoracic Society guidelines for the management of community acquired pneumonia in adults: update 2009. Thorax 2009;iii:1-55.

7. Gilbert D. Procalcitonin as a biomarker in respiratory tract infection. Clin Infect Dis 2011;52:S346.

8. Christ-Crain M, Jaccard-Stolz D, Bingisser R, et al. Effect of procalcitonin guided treatment on antibiotic use and outcome in lower respiratory tract infections: clusterrandomised, single blinded intervention trial. Lancet 2004;363:600.

9. ChristCrain M, Stolz D, Bingisser R, et al. Procalcitonin guidance of antibiotic therapy in community acquired pneumonia: a randomized trial. Am J Respir Crit Care Med 2006;174:84.

10. Holm A, Nexoe J, Bistrup LA, et al. Aetiology and prediction of pneumonia in lower respiratory tract infection in primary care. Br J Gen Pract 2007;57:547.

11. Angoulvant E. Reglas de interpretación de la infecciones por Candida. Acta Bioquím Clín Latinoam 2007;41:587-593.

12. Badager J, Santillana S, Garibay H, Gómez E y col. Guía de práctica clínica CENETEC. Prevención, diagnóstico y tratamiento de la neumonía adquirida en la comunidad en adultos. Secretaría de Salud, 2009.

13. Mandell L, Wunderink R, Anzueto A, Bartlett J, et al. Infectious Diseases Society of America/American Thoracic Society Consensus Guidelines on the Management of Community- Acquired Pneumonia in Adults. CID 2007;44:S27- S72.

14. Báez R, Gómez C, López C, Molina H y col. Neumonía adquirida en la comunidad. Revisión y actualización con una perspectiva orientada a la calidad de la atención médica. Neumol Cir Tórax 2013;72:6-43.

15. Johnstone J, Mandell L. Guidelines and Quality Measures. Do they improve outcomes of patients with communityacquired pneumonia? Infect Dis Clin N Am 2013;27:71-86.

16. Simonetti A, Viasus D, García C, Carratalá J. Management of community-acquired pneumonia in older adults. Ther Adv Infect Dis 2014;2:3-16.

17. Lim W, Baudouin S, George R, Hill A, et al. British Thoracic Society guidelines for the management of community acquired pneumonia in adults: update 2009. Thorax 2009;iii:1-55.

18. Gilbert D. Procalcitonin as a biomarker in respiratory tract infection. Clin Infect Dis 2011;52:S346.

19. Christ-Crain M, Jaccard-Stolz D, Bingisser R, et al. Effect of procalcitonin guided treatment on antibiotic use and outcome in lower respiratory tract infections: clusterrandomised, single blinded intervention trial. Lancet 2004;363:600.

20. ChristCrain M, Stolz D, Bingisser R, et al. Procalcitonin guidance of antibiotic therapy in community acquired pneumonia: a randomized trial. Am J Respir Crit Care Med 2006;174:84.

21. Holm A, Nexoe J, Bistrup LA, et al. Aetiology and prediction of pneumonia in lower respiratory tract infection in primary care. Br J Gen Pract 2007;57:547.

22. Angoulvant E. Reglas de interpretación de la infecciones por Candida. Acta Bioquím Clín Latinoam 2007;41:587-593.