Pneumonia treated in the internal medicine department: focus on healthcare-associated pneumonia
Por:
Giannella, M, Pinilla, B, Capdevila, JA, Alarcon, JM, Munoz, P, Alvarez, JL, Bouza, E, Pou, Jordi Casademont, SEMI
Publicada:
1 ago 2012
Resumen:
Clin Microbiol Infect Abstract Patients with pneumonia treated in the internal medicine department (IMD) are often at risk of healthcare-associated pneumonia (HCAP). The importance of HCAP is controversial. We invited physicians from 72 IMDs to report on all patients with pneumonia hospitalized in their department during 2 weeks (one each in January and June 2010) to compare HCAP with community-acquired pneumonia (CAP) and hospital-acquired pneumonia (HAP). We analysed 1002 episodes of pneumonia: 58.9% were CAP, 30.6% were HCAP and 10.4% were HAP. A comparison between CAP, HCAP and HAP showed that HCAP patients were older (77, 83 and 80.5 years; p < 0.001), had poorer functional status (Barthel 100, 30 and 65; p < 0.001) and had more risk factors for aspiration pneumonia (18, 50 and 34%; p < 0.001). The frequency of testing to establish an aetiological diagnosis was lower among HCAP patients (87, 72 and 79; p < 0.001), as was adherence to the therapeutic recommendations of guidelines (70, 23 and 56%; p < 0.001). In-hospital mortality increased progressively between CAP, HCAP and HAP (8, 19 and 27%; p < 0.001). Streptococcus pneumoniae was the main pathogen in CAP and HCAP. Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus (MRSA) caused 17 and 12.3% of HCAP. In patients with a confirmed aetiological diagnosis, the independent risk factors for pneumonia due do difficult-to-treat microorganisms (Enterobacteriaceae, P. aeruginosa or MRSA) were HCAP, chronic obstructive pulmonary diseases and higher Port Severity Index. Our data confirm the importance of maintaining high awareness of HCAP among patients treated in IMDs, because of the different aetiologies, therapy requirements and prognosis of this population.
Filiaciones:
Giannella, M:
Hosp Gen Univ Gregorio Maranon, Dept Clin Microbiol & Infect Dis, Madrid 28007, Spain
Pinilla, B:
Hosp Gen Univ Gregorio Maranon, Dept Internal Med, Madrid 28007, Spain
Capdevila, JA:
Hosp Mataro, Dept Internal Med, Mataro, Spain
Alarcon, JM:
Hosp Gen Univ Ciudad Real, Dept Clin Microbiol, Ciudad Real, Spain
Munoz, P:
Hosp Gen Univ Gregorio Maranon, Dept Clin Microbiol & Infect Dis, Madrid 28007, Spain
CIBER Enfermedades Resp CIBERES, Palma De Mallorca, Spain
Alvarez, JL:
Hosp Univ Principe Asturias, Dept Internal Med, Madrid, Spain
Bouza, E:
Hosp Gen Univ Gregorio Maranon, Dept Clin Microbiol & Infect Dis, Madrid 28007, Spain
CIBER Enfermedades Resp CIBERES, Palma De Mallorca, Spain
Pou, Jordi Casademont:
Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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