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Vol. 35. Issue 1.
Pages 27-32 (January 1999)
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Vol. 35. Issue 1.
Pages 27-32 (January 1999)
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Neumonía adquirida en la comunidad remitida al medio hospitalario. Epidemiología y actitud diagnóstica y terapéutica
Community-acquired pneumonia referred for hospital management: epidemiology and diagnostic and therapeutic approaches
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J.A. Carretero Graciaa,*, T. Nebreda Mayoralb, A.I. Acereda Ridruejoc, Y. Larumbe Solac, M.A. Martínez Gutiérrezc, C. Tierno Sanquiricoc
a Servicios de Medicina Interna. Unidad de Neumología
b Servicios de Microbiología. Hospital General de Soria.
c Servicios de Unidad Docente de Medicina Familiar y Comunitaria de Soria
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Objetivos

Conocer la situación epidemiológica de la neumonía adquirida en la comunidad remitida al medio hospitalario y la actitud diagnóstica y terapéutica que adopta el médico frente a la misma.

Método

Estudio epidemiológico retrospectivo y clínico descriptivo basado en la historia clínica de los pacientes con criterios de neumonía adquirida en la comunidad (Fang et al. Medicine 1990; 69: 307-316) remitidos a los hospitales de Soria durante un año. Los pacientes se agruparon en función de la gravedad y presencia de factores de riesgo para una etiología no habitual y se comparó la actitud inicial con la propuesta por diversas normativas.

Resultados

Se diagnosticaron 308 neumonías adquiridas en la comunidad; ingresaron el 82%. La edad media de los pacientes fue de 68 ± 26 años (el 43% mayores de 80 años). El 56% fueron varones; 217 (70%) tenían criterios de gravedad, 203 (66%) tenían factores de riesgo para una etiología no habitual y 166 (54%) ambos. La mortalidad global en los ingresados fue del 13%. La investigación etiológica no se ajustó a la normativa de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR), logrando una identificación microbiológica en un 5% de los pacientes. El tratamiento empírico se ajustó a normativa SEPAR en el 45% de los casos, en el 23% a la guía Mensa y en el 20% a la guía Sanford.

Conclusiones

La incidencia de neumonía adquirida en la comunidad en este estudio es de 3,2 casos por 1.000 habitantes/año, población mayoritariamente envejecida y con frecuente comorbilidad aunque la mortalidad global es baja. Creemos necesario adoptar criterios comunes en el manejo de la neumonía adquirida en la comunidad y ajustar el tratamiento empírico a los gérmenes identificados en cada medio realizando una investigación etiológica correcta.

Palabras clave:
Neumonía adquirida en la comunidad
Objectives

To determine the epidemiology of community acquired pneumonia referred to the hospital and to characterize the diagnostic and therapeutic approach adopted by physicians.

Method

Retrospective epidemiological and descriptive ciinical study based on case histories consistent with a diagnosis of community-acquired pneumonia (Fang et al. Medicine, 1990; 69:307-16) of patients referred to hospitals in Soria (Spain) over a period of one year. The patients were grouped by severity and the presence of risk factors for unusual etiology. Initial approaches were compared to those advocated by various sources.

Results

Three hundred eight cases of community-acquired pneumonia were diagnosed, and 82% of the patients were admitted. Mean age was 68±26 years (43% over 80 years of age). Men accounted for 56%. Two hundred seventeen patients (70%) were classified as seriously ill, 203 (66%) had risk factors for unusual etiology, and 166 (54%) were classified in both categories. Mortality among admitted patients was 13%. Etiological diagnoses did not correspond to the guidelines of the Spanish Society of Pneumology and Chest Surgery (SEPAR), with microbial identification achieved in 5%. Empirical treatment followed SEPAR guidelines in 45% of the cases. The Mensa guidelines were followed in 23% and the Sanford guidelines in 20%.

Conclusions

The incidence of community-acquired pneumonia in this population is 3.2 cases per 1,000 inhabitants/year. The population is mainly elderly and comorbidity is common, although mortality is low. We believe common criteria should be adopted for managing community-acquired pneumonia and that empirical treatment should be directed toward germs identified in each setting, based on appropriate etiological investigation.

Key words:
Community-aequired pneumonia
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Copyright © 1999. Sociedad Española de Neumología y Cirugía Torácica
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