Community-acquired pneumonia at the Hospital de Clínicas de Porto Alegre: evaluation of a care protocol

Abstract

To assess the adequacy of medical prescriptions for community-acquired pneumonia at the emergency department of the Hospital de Clínicas de Porto Alegre, we conducted a prospective cohort study, from January through April 2011. All patients with suspected pneumonia were selected from the first prescription of antimicrobials held in the emergency room. Patients with a description of pneumonia, community-acquired pneumonia, respiratory infection, or other issues related to community-acquired pneumonia were selected for review. Two-hundred and fifteen patients were studied. Adherence to the hospital care protocol was: 11.2% for the initial recommended tests (chest X-ray and collection of sputum sample), 34.4% for blood cultures, and 92.1% for the antimicrobial choice. Sixty percent of the prescriptions consisted of a combination of drugs, and the association of beta-lactam and macrolide was the most common. The Hospital Infection Control Committee evaluated patients' prescriptions within a median time of 23.5h (IQR 25-75%, 8-24). Negative evaluations accounted for 10% of prescriptions (n=59). Fourteen percent of the patients died during hospitalization. In the multivariate analysis, Pneumonia Severity Index Score and use of ampicillin+sulbactam alone were independently related to in-hospital mortality. There was a high adherence to the hospital's CAP protocol, in relation to antimicrobial choice. Severity score and use of ampicillin+sulbactam alone were independently associated to in-hospital death.

A prospective observational study of community acquired pneumonia in Kenya: the role of viral pathogens

“…Seventy-five of the 77 enrolled patients had a nasopharyngeal swab obtained for viral PCR using the Resp21 assay as part of the study protocol for 71 patients, while four were tested by PCR using the Altona influenza and RSV tests. Other tests were done as determined by the admitting physician and included blood cultures (60) and sputum [ 30 ]. Bronchoscopy was done in seven.…”

“…A study done in Nigeria [ 39 ], revealed 38.8% of patients with CAP had at least one NCD. Studies from high and middle income countries have also shown that NCDs are common in patients presenting with pneumonia [ 30 , 40 , 41 ] and are linked to increased morbidity and mortality [ 42 – 45 ]. The high percentage of patients with NCDs in this study reflect the risk factors of a growing middle class in Nairobi and may be an indication of trends relevant to SSA [ 5 – 7 ].…”

Tendência temporal das internações por pneumonia em adultos e idosos na cidade do Salvador-Bahia, no período de 2003 a 2016

“…A doença pode ser causada por diversos agentes infecciosos entre os quais prevalecem as bactérias, principalmente, o Streptococcus pneumoniae e o Haemophilus influenzae; os vírus, a exemplo do vírus sincicial respiratório e do influenza, e os fungos, como o Pneumocystis jiroveci (OMS, 2016;POHA, 2016). A pneumonia mais frequente é a bacteriana, que atinge principalmente crianças menores de cinco anos de idade e idosos, sendo, dentre estes últimos, mais propensos os de idade superior a 65 anos (MEDEIROS et al, 2016;MOCELIN;DOS SANTOS, 2013) A cada ano, cerca de 1,6 milhões de pessoas morrem por pneumonia pneumocócica no mundo (POHA, 2016). Em um estudo longitudinal, analisando-se a tendência do coeficiente de mortalidade por pneumonia nas diversas regiões do Brasil, identificou-se o crescimento do coeficiente de óbitos em 10 entre 1996 e 2012.…”