Giannella, Maddalena (2012) Estudio de neumonía en medicina interna en España. [Thesis]
BAKGROUND: A high proportion of hospitalized patients with pneumonia are treated in Internal Medicine Departments (IMDs). However, information on pneumonia in this setting is scarce. METHODS: We invited physicians working in 72 IMDs to report on all patients with pneumonia hospitalized in their department during two-week-study period (January and June 2010). RESULTS: Overall, 1,002 episodes of pneumonia were analyzed. Incidence was 111 episodes per 1,000 IMD admissions. Patients were classified as having community-acquired (CAP) (58.9%), health-care– acquired (HCAP) (30.6%) and hospital-acquired pneumonia (HAP) (10.4%). According to PSI and CURB-65 scores, the admissions seemed unnecessary ranged from 24% to 30%. Etiologic diagnostic testing (≥1 sample) was made in 87%, 72%, and 79% of CAP, HCAP, and HAP (p<0.001), with an overall yield of 29%. S. pneumoniae was the main pathogen in CAP and HCAP cases. However, P. aeruginosa, MRSA and Enterobacteriaceae caused 16.9%, 12.3% and 12.3% of HCAP episodes, respectively. Overall, 30% of patients did not receive any antibiotic within 6 hours of evaluation. Adherence to the therapeutic recommendations of guidelines was 70%, 23% and 56% in CAP, HCAP and HAP (p<0.001). Switched therapy was performed in 60% of patients, and discharge was delayed for a median of 5 days from the clinical stability. In-hospital mortality was 8%, 19%, and 27% for CAP, 8. ANEXOS 230 HCAP, and HAP (p<0.001). In the multivariate analysis age, underlying diseases, hospital acquisition and severity of pneumonia were independently associated with mortality, while adherence to guidelines improved survival. Only 2% of patients were vaccinated against S. pneumoniae at discharge. CONCLUSIONS: Pneumonia represents a high proportion of the workload (11%) of the IMDs. HCAP is frequently unrecognised and inadequately treated at admission. There is room for improvement in the management of pneumonia in this important setting.
Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, leída el 04-06-2012
|Subjects:||Medical sciences > Medicine > Pneumology|
|Deposited On:||23 Nov 2012 09:51|
|Last Modified:||23 Nov 2012 09:51|
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