Neumonía y servicios médicos

La neumonía vinculada con los servicios médicos suele ser más letal
( Outcomes of Patients Hospitalized With Community-Acquired, Health Care–Associated, and Hospital-Acquired Pneumonia )
Mario Venditti, MD; Marco Falcone, MD; Salvatore Corrao, MD; Giuseppe Licata, MD; Pietro Serra, MD; and the Study Group of the Italian Society of Internal Medicine* Annals 2009 150: I-36. 6 January 2009 Volume 150 Issue 1 Pages 19-26.
En este estudio publicado en Anales de Medicina Interna y conducido por médicos italianos de la Universidad de Roma, se ha encontrado que la gravedad y mortalidad de la neumonía provocada por el contacto con un paciente ambulatorio en un centro de asistencia médica es mayor que la generada por la enfermedad adquirida en la comunidad. Se encontró en el estudio que los peores resultados se encontraron con el tratamiento inadecuado de antibióticos.
Los resultados del estudio revelan que comparando los resultados de 362 pacientes tratados en 55 hospitales durante el 2007 por neumonía adquirida en la comunidad, el hospital u otro establecimiento de asistencia médica, la neumonía asociada con la atención médica ambulatoria fue más severa, requirió más días de hospitalización y las tasas de mortalidad fueron más elevadas (un 17,8 frente a un 6,7 por ciento). La tasa de mortalidad de la neumonía adquirida en el hospital fue aún mayor, siendo del 18,4 por ciento.
Dentro de la investigación se encontró además, que menos del 30 por ciento de los pacientes con neumonía asociada con la asistencia médica recibían los antibióticos recomendados, comparado con el 60 o 70 por ciento de los otros pacientes.
Por otro lado, se encontró, que para mejorar los resultados de la neumonía vinculada a la atención médica, se aconseja que la terapia con antibióticos pueda combatir el Staphylococcus aureus resistente a la meticilina o SARM y otros organismos resistentes a múltiples fármacos.
Para quién quiera leer el artículo completo, lo encontrarán a continuación
Outcomes of Patients Hospitalized With Community-Acquired, Health Care–Associated, and Hospital-Acquired Pneumonia
Mario Venditti, MD; Marco Falcone, MD; Salvatore Corrao, MD; Giuseppe Licata, MD; Pietro Serra, MD; and the Study Group of the Italian Society of Internal Medicine* 6 January 2009 Volume 150 Issue 1 Pages 19-26
Background: Traditionally, pneumonia has been classified as either community- or hospital-acquired. Although only limited data are available, health care–associated pneumonia has been recently proposed as a new category of respiratory infection. "Health care–associated pneumonia" refers to pneumonia in patients who have recently been hospitalized, had hemodialysis, or received intravenous chemotherapy or reside in a nursing home or long-term care facility. Objective: To ascertain the epidemiology and outcome of community-acquired, health care–associated, and hospital-acquired pneumonia in adults hospitalized in internal medicine wards. Design: Multicenter, prospective observational study. Setting: 55 hospitals in Italy comprising 1941 beds. Patients: 362 patients hospitalized with pneumonia during two 1-week surveillance periods. Measurements: Cases of radiologically and clinically assessed pneumonia were classified as community-acquired, health care–associated, or hospital-acquired and rates were compared. Results: Of the 362 patients, 61.6% had community-acquired pneumonia, 24.9% had health care–associated pneumonia, and 13.5% had hospital-acquired pneumonia. Patients with health care–associated pneumonia had higher mean Sequential Organ Failure Assessment scores than did those with community-acquired pneumonia (3.0 vs. 2.0), were more frequently malnourished (11.1% vs. 4.5%, and had more frequent bilateral (34.4% vs. 19.7%) and multilobar (27.8% vs. 21.5%) involvement on a chest radiograph. Patients with health care–associated pneumonia also had higher fatality rates (17.8% [CI, 10.6% to 24.9%] vs. 6.7% [CI, 2.9% to 10.5%]) and longer mean hospital stay (18.7 days [CI, 15.9 to 21.5 days] vs. 14.7 days [CI, 13.4 to 15.9 days]). Logistic regression analysis revealed that depression of consciousness (odds ratio [OR], 3.2 [CI, 1.06 to 9.8]), leukopenia (OR, 6.2 [CI, 1.01 to 37.6]), and receipt of empirical antibiotic therapy not recommended by international guidelines (OR, 6.4 [CI, 2.3 to 17.6]) were independently associated with increased intrahospital mortality. Limitations: The number of patients with health care–associated pneumonia was relatively small. Microbiological investigations were not always homogeneous. The study included only patients with pneumonia that required hospitalization; results may not apply to patients treated as outpatients.
Conclusion: Health care–associated pneumonia should be considered a distinct subset of pneumonia associated with more severe disease, longer hospital stay, and higher mortality rates. Physicians should differentiate between patients with health care–associated pneumonia and those with community-acquired pneumonia and provide more appropriate initial antibiotic therapy.