Impacto del estudio microbiológico en la neumonía comunitaria grave.
ABSTRACT Study objectives: The study documents the impact of microbiologic investigations on therapeutic decisions and outcome in severe CAP. Design: Retrospective analysis of prospectively collected data. Setting: ICUs in two teaching Spanish hospitals. Patients: Two hundred and four consecutive patients admitted to intensive care with severe CAP. Interventions: None. Measurements and Results: One hundred and six patients required intubation, while 98 other did not (81 of these patients having been managed with noninvasive mechanical ventilation). The microbiologic diagnosis was established in 57.3% of patients. The most common pathogens were Streptococcus pneumoniae, Legionella pneumophila and Haemophilus influenzae. Pseudomonas (6.6.% vs 1.0%, p<0.05) and Legionella (15.1% vs. 7.1%, p<0.05) were more frequently documented in intubated patients. Overall mortality was 23.5% (44.3% in intubated patients), with Streptococcus pneumoniae (7 cases), Pseudomonas aeruginosa (7), and Legionella pneumophila (5) being the most common lethal pathogens. Bacteriological investigation led to changes in antibiotic prescription in 41.6% of patients, including 11 (5%) in whom initial treatment was ineffective against the microbial isolates. The most frequent reason for changes was simplification of therapy in 65 (31.8%) episodes. Conclusions: We conclude that microbiological testing is fully justified in patients with SCAP, because identifying the causative and adjusting treatment bear impact on patient outcome. Our findings suggested that intubated patients should be empirically treated for Pseudomonas and Legionella while awaiting bacteriology results.
Advisor:Rello Condomines, Jordi; Pujol del Pozo, Andreu
School:Universitat Rovira i Virgili
Source Type:Master's Thesis
Keywords:departament de ciències mèdiques bàsiques
Date of Publication:10/03/2002