Publication: Estudio de neumonía en medicina interna en España
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2012-11-23
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Universidad Complutense de Madrid
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Abstract
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.
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, leída el 04-06-2012