Retrospective epidemiological study for the characterization of community- acquired pneumonia and pneumococcal pneumonia in adults in a well-defined area of Badalona (Barcelona, Spain)

Abstract

BackgroundCommunity-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.MethodsMedical records were identified by codes from the International Classification of Diseases in databases (January 1st 2008-December 31st 2009).ResultsA 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.ConclusionsStrategies preventing CAP, thus reducing hospital admissions could likely produce substantial costs savings in addition to the reduction of CAP burden.

Influence of chronic illnesses and underlying risk conditions on the incidence of pneumococcal pneumonia in older adults

“…We note that incidence was threefold greater in persons with any underlying risk condition as compared with healthy subjects without risk conditions (2.56 vs 0.80 cases per 1000 person-year, respectively). Overall case fatality rate was considerable (10.4 %), but it appears in the low limit of case fatality rates observed in adults with pneumococcal pneumonia, where values ranging between 3 and 35 % have been reported [19][20][21][22].…”

Burden of pneumococcal community-acquired pneumonia in adults across Europe: A literature review

“…The countries with the most data sources were Spain (23 studies plus an additional study combining Italian and Spanish data) [5,25,28,49,[59][60][61][62][63][64][65][66][67][68][69][70][71][72][73][74][75][76][77][78] and the United Kingdom (14 studies) [80][81][82][83][84][85][86][87][88] followed by Italy (7 plus the additional study combining Italian and Spanish data) [42][43][44][45][46][47][48][49], the Netherlands (6 studies) [21,27,[50][51][52][53], Germany [26,[37][38]…”

Chronic comorbidity of internal organs as a risk factor of complications and fatal outcome of community-acquired pneumonia.

“…Високі показники поширеності супутньої патології в госпіталізованих пацієнтів з індексом коморбідності на рівні 7,8±4,2 відмічали A. Sicras-Mainar et al (2012) [9].…”