Community-acquired pneumonia -: Etiology, epidemiology, and outcome at a teaching hospital in Argentina

被引:136
作者
Luna, CM
Famiglietti, A
Absi, R
Videla, AJ
Nogueira, FJ
Fuenzalida, AD
Gené, RJ
机构
[1] Hosp Clin Jose de San Martin, Dept Med, Div Pulm, Buenos Aires, DF, Argentina
[2] Univ Buenos Aires, Fac Biochem, Dept Clin Biochem, RA-1053 Buenos Aires, DF, Argentina
关键词
Argentina; comorbidities; community-acquired pneumonia; epidemiology; etiology; guidelines; mortality; outcome; South America; therapy;
D O I
10.1378/chest.118.5.1344
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Objective: To survey the etiology and epidemiology of community-acquired pneumonia (CAP) in relation to age, comorbidity, and severity and to investigate prognostic factors. Design: Prospective epidemiologic study single center. Setting: University hospital at Buenos Aires, Argentina. Patients: Outpatients and inpatients fulfilling clinical criteria of CAP. Interventions: Systematic laboratory evaluation for determining the etiology, and clinical evaluation stratifying patients into mild, moderate, and severe CAP (groups 1 to 3), a clinical rule used for hospitalization. Results: During a 12-month period, 343 patients (mean age, 64.4 years; range, is to 102 years) were evaluated. We found 167 microorganisms in 144 cases (yield, 42%). Streptococcus pneumoniae, the most common pathogen, was isolated in 35 cases (24%). Mycoplasma pneumoniae, present in 19 (13%), was second infrequency in group 1; Haemophilus influenzae, present in 17 cases (12%), was second in group 2; and Chlamydia pneumoniae, present in 12 cases (8%), was second in group 3. Etiology could not be determined on the basis of clinical presentation; identifying the etiology had no impact on mortality. Some findings were associated with specific causative organisms and outcome. A significantly lower number of nonsurvivors received adequate therapy (50% vs 77%). Conclusions: Age, comorbidities, alcohol abuse, and smoking were related with distinct etiologies. Pao(2) to fraction of inspired oxygen ratio < 250, aerobic Gram-negative pathogen, chronic renal failure, Glasgow score < 15, malignant neoplasm, and aspirative pneumonia were associated with mortality by multivariate analysis. Local microbiologic data could be of help in tailoring therapeutic guidelines to the microbiologic reality at different settings. The stratification schema and the clinical rule used for hospitalization were useful.
引用
收藏
页码:1344 / 1354
页数:11
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