[Clinical management of community-acquired pneumonia in adults].
Available from: Lorenzo Aguilar
- "Despite different available diagnostic tests for CAP, only in nearly 50% of CAP patients the etiological agent is identified [7,9-15], Streptococcus pneumoniae being the most frequently identified pathogen [2,16,17]. An adequate clinical assessment for patient classification according to severity prediction factors is essential in CAP management in order to determine the most adequate setting for treatment [13,18-20]. Antimicrobial treatment is empirically initiated after assessing severity, etiology and resistance prevalence in the setting [21-25]. "
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Community-acquired pneumonia (CAP) has large impact on direct healthcare costs, especially those derived from hospitalization. This study determines impact, clinical characteristics, outcome and economic consequences of CAP in the adult (≥18 years) population attended in 6 primary-care centers and 2 hospitals in Badalona (Spain) over a two-year period.
Medical records were identified by codes from the International Classification of Diseases in databases (January 1st 2008-December 31st 2009).
A total of 581 patients with CAP (55.6% males, mean age 57.5 years) were identified. Prevalence: 0.64% (95% CI: 0.5%-0.7%); annual incidence: 3.0 cases/1,000 inhabitants (95% CI: 0.2-0.5). Up to 241 (41.5%) required hospitalization. Hospital admission was associated (p<0.002) with liver disease (OR=5.9), stroke (OR=3.6), dementia (OR=3.5), COPD (OR=2.9), diabetes mellitus (OR=1.9) and age (OR=1.1 per year). Length of stay (4.4±0.3 days) was associated with PSI score (β=0.195), in turn associated with age (r=0.827) and Charlson index (r=0.497). Microbiological tests were performed in all inpatients but only in 35% outpatients. Among patients with microbiological tests, results were positive in 51.7%, and among them, S pneumoniae was identified in 57.5% cases. Time to recovery was 29.9±17.2 days. Up to 7.5% inpatients presented complications, 0.8% required ICU admission and 19.1% readmission. Inhospital mortality rate was 2.5%. Adjusted mean total cost was €2,332.4/inpatient and €698.6/outpatient (p<0.001). Patients with pneumococcal CAP (n=107) showed higher comorbidity and hospitalization (76.6%), higher PSI score, larger time to recovery and higher overall costs among inpatients.
Strategies preventing CAP, thus reducing hospital admissions could likely produce substantial costs savings in addition to the reduction of CAP burden.
BMC Infectious Diseases 11/2012; 12(1):283. DOI:10.1186/1471-2334-12-283 · 2.61 Impact Factor
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ABSTRACT: This study compares the ability of the Pneumonia Severity Index (PSI) and the British Thoracic Society CURB-65 and CRB-65 rules in predicting short-term mortality among elderly patients with community-acquired pneumonia (CAP).
It is a population-based study including all people over 65 years old with a radiographically confirmed CAP in the region of Tarragona (Spain) between 2002 and 2008. Treatment setting and clinical variables were considered for each patient. PSI, CURB-65 and CRB-65 scores were calculated at the moment of diagnosis and 30-day mortality was considered as a main dependent variable. The rules were compared based on sensitivity, specificity and area under the receiver operating characteristic curve (AUC).
Of the total 590 CAP cases, mortality rate was 13.6% (15.3% in hospitalised and 1.4% in outpatient cases; p = 0.001). Mortality increased with increasing PSI score (None in class II, 6,9% in class III, 14,4% in class IV and 29,5% in class V), CURB-65 score (7.5%, 14.5%, 26.7%, 53.3% and 100% for scores 1,2,3,4 and 5 respectively) and CRB-65 score (6.6%, 26.1%, 40.5% and 50% for scores 1,2,3 and 4 respectively). The three rules performed too similarly to predict 30-day mortality, with a ROC area of 0.727 [95% confidence interval (CI): 0.67-0.79] for the PSI, 0.672 (95% CI: 0.61-0.74) for the CURB-65, and 0.719 (95% CI: 0.65-0.78) for the CRB-65.
Our data shows that the analysed rules perform equally well among elderly people with CAP which supports the recommendation for using the simplified CRB-65 severity score among elderly patients in primary care or emergency visits.
International Journal of Clinical Practice 09/2011; 65(11):1165-72. DOI:10.1111/j.1742-1241.2011.02742.x · 2.57 Impact Factor
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ABSTRACT: OBJECTIVE: To compare the ability of the classic CRB65 (confusion, respiratory rate, blood pressure and age ≥65 years) vs the modified CRB-75 for the severity assessment of patients 65 years or older with community acquired pneumonia (CAP). DESIGN: Prospective cohort study. SETTING: Tarragona Health Region. PARTICIPANTS: A total of 350 patients ≥65 years with a radiographically confirmed CAP (hospitalized or outpatient) during 2008-2010. MAIN OUTCOME MEASURES: The CRB-65 score (confusion; respiratory rate ≥30; systolic blood pressure<90mmHg or diastolic ≤ 60mmHg; age ≥65 years) and the modified CRB-75 (similar criteria but age ≥75 years) were calculated at the time of diagnosis, and 30-day mortality was considered as the main dependent variable. RESULTS: The overall 30-day mortality rate was 13.1% (4% in outpatient CAP and 15% in hospitalized CAP). According to CRB-65, mortality was 7,7% with a score of 1, 22.5% with a score of 2, and 50% with a score of 3 (no cases with a score of 4). Mortality also directly increased according to CRB-75, being 3,2% with a score of 0, 9,7% with a score of 1, 30.0% with a score of 2, and 45.5% with a score of 3. The discriminative value of both CRB65 and CRB75 rules to classify risk of short-term mortality among our study population was acceptable, with a better area under receive operating characteristic curve (ROC) for CRB75 than for CRB-65 (0,735 vs 0,681; P<.01). CONCLUSION: Both CRB-65 and CRB-75 scales are an acceptable tool to classify mortality risk among elderly patients with CAP. However, CRB-75 can be more useful for evaluating patients over 65 years with CAP.
Atención Primaria 01/2013; · 0.95 Impact Factor
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