a study was performed in a mixed residential-industrial urban population of the "Maresme" region in Barcelona, Spain. All subjects $14 yrs of age (annual average population size 74,368 inhabitants) with clinically suspected community-acquired pneumonia were registered. All cases were re-evaluated by chest radiographs on the 5th day of illness and at monthly intervals until complete recovery. Urine and blood samples were obtained for culture and antigen detection. When lower respiratory tract secretions were obtained, these were also cultured.There were 241 patients with community-acquired pneumonia, with an annual incidence rate of 1.62 cases (95% confidence interval, 1.42±1.82) per 1,000 inhabitants. Incidence rates increased by age groups and were higher in males than in females. Of 232 patients with aetiological data, 104 had an identifiable aetiology. A total of 114 pathogens were found (single pathogen 94, two pathogens 10). There were 81 episodes of bacterial infection and 33 of viral infection. The most common pathogens were Streptococcus pneumoniae, Chlamydia pneumoniae, and influenza A and B viruses. No case of Hantavirus infection was found. The rate of hospital admission was 61.4% with a mean SD length of 11.7 10.1 days, a mean period of 23.0 14.3 days inactivity, and an overall mortality rate of 5%.The high rate of hospital admission, prolonged stay in hospital, and long period of inactivity all continue to constitute a social and health care burden of communityacquired pneumonia. Eur Respir J 2000; 15: 757±763.

Risk factors for community-acquired pneumonia in adults: a population-based case± control study. J. Almirall, I. BolõÂ bar, X. Balanzo Â, C.A. Gonza Âlez. #ERS Journals Ltd 1999. ABSTRACT: Although community-acquired pneumonia (CAP) remains a major cause of hospitalization and death, few studies on risk factors have been performed. A population-based case±control study of risk factors for CAP was carried out in a mixed residential±industrial urban area of 74,610 adult inhabitants in the Maresme (Barcelona, Spain) between 1993 and 1995.All patients living in the area and clinically suspected of having CAP at primary care facilities and hospitals were registered. In total, 205 patients with symptoms, signs and radiographic infiltrate compatible with acute CAP participated in the study. They were matched by municipality, sex and age with 475 controls randomly selected from the municipal census. Risk factors relating the subject's characteristics and habits, housing conditions, medical history and treatments were investigated by means of a questionnaire.In the univariate analysis, an increased risk of CAP was associated with low body mass index, smoking, respiratory infection, previous pneumonia, chronic lung disease, lung tuberculosis, asthma, treated diabetes, chronic liver disease, and treatments with aminophiline, aerosols and plastic pear-spacers. In multivariate models, the only statistically significant risk factors were current smoking of >20 cigarettes . day -1 (odds ratio (OR)=2.77; 95% confidence interval (CI) 1.14±6.70 compared with never-smokers), previous respiratory infection (OR=2.73; 95% CI 1.75±4.26), and chronic bronchitis (OR=2.22; 95% CI 1.13±4.37). Benzodiazepines were found to be protective in univariate and multivariate analysis (OR=0.46; 95% CI 0.23±0.94).This population-based study provides new and better established evidence on the factors associated with the occurrence of pneumonia in the adult community. Eur Respir J 1999; 13: 349±355. Although community-acquired pneumonia (CAP) remains a major cause of hospitalization and a common cause of death in developed countries, few population-based studies on its incidence and risk factors have been published. In the USA the incidence of CAP has been estimated as 15 episodes for every 1,000 persons per year [1]. Approximately 15% of pneumonia cases require hospitalization and the mortality rate reaches 24.1 per 100,000 inhabitants, in fifth place after cardiovascular, neoplastic, cerebrovascular and chronic bronchitic (CB) diseases [2,3]. The incidence of CAP is lower in Europe: 5 per 1,000 in people aged 15±79 yrs in England [4], 9 per 1,000 inhabitants >14 yrs in Finland [5] and 2.6 per 1,000 persons >13 yrs in Spain [6]. Hospitalization rates in these studies were 42, 13 and 50%, respectively. The incidence of CAP [5,7] and the length of hospital stay [8] are higher in the elderly than in young adults; hence, the current demographic ageing will lead to worsening of the problem.Respiratory host defences, through mechanical, humoral and cellula...

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A population-based study of the costs of care for community-acquired pneumonia. M. Bartolomé, J. Almirall, J. Morera, G. Pera, V. Ortún, J. Bassa, I. Bolíbar, X. Balanzó, A. Verdaguer, and the Maresme Community-Acquired Pneumonia Study Group (GEMPAC). #ERS Journals Ltd 2004. ABSTRACT: In a population-based study, the consumption of resources for treating adult patients with community-acquired pneumonia was determined.During a 2-yr period, all cases with a clinical and radiological suspicion of community-acquired pneumonia that occurred in patients aged w14 yrs in a community of 74,610 inhabitants were investigated prospectively.Of 292 cases with a suspicion of community-acquired pneumonia, 224 were included (18.5% misdiagnoses). The mean number of visits per patient was 4.5 (72% in the primary care setting). Inpatient care was recommended in 59.8% of cases; after discharge, 44% of patients were managed in outpatient clinics. The mean direct cost of pneumonia treated in the hospital setting was J (euros)1,553, whereas the mean cost of cases treated as outpatients was J196. A total of 15.7% of admissions were considered inappropriate and the length of stay could have been reduced by 3.5 days in the most severe cases. A reduction in inappropriate admissions and lengths of hospital stay would result in a decrease in cost of 17.4%.Community-acquired pneumonia in Maresme, Spain, occurs at a low incidence, although with a high percentage of hospitalisations (in part inappropriate), resulting in considerable costs.