RESUMO
Community-acquired pneumonia (CAP) is a potentially serious infection that results in numerous general practitioner visits and hospital admissions each year. Objective: to evaluate the clinical management of CAP by general practitioners in the emergency setting. Results: From April 1 to September 30, 2003, 3,701 adult cases of CAP were reported in Viña del Mar and Quillota Health Service, 73 percent of cases presented to emergency department and 27 percent to primary care units. Overall, 84 percent were treated as ambulatory patients and 16 percent were admitted to hospital. During a 6-month period, 229 ambulatory patients with CAP ( +/- SD = 56 +/- 21 years old) were prospectively evaluated in the emergency setting. Patients with CAP class I (40 percent) were treated with Clarithromycin (67.4 percent) or Amoxicillin (32.6 percent) during 10 days; and CAP type II cases (60 percent) were treated with Amoxicillin-clavulanate (74.5 percent) or Levofloxacin (24.8 percent) during 10 days. 226 of initial ambulatory patients (98.7 percent) were cured without hospitalization; three patients (1.3 percent) were subsequently hospitalized because of the failure of ambulatory treatment. Overall, three patients (1.3 percent) died; all deaths occurred during or immediately after hospitalization and were related to the severity of lung infection but not to the choice of antibiotic treatment. Conclusions: The majority of adult patients with CAP, without clinical severity criteria, could be managed as outpatients with low rates of hospital admission and mortality.
La neumonía adquirida en la comunidad (NAC) constituye una causa frecuente de consulta ambulatoria y hospitalización en la población adulta. Objetivos: describir el manejo de la NAC del adulto en el Servicio de Salud de Viña del Mar y Quillota durante la Campaña de Invierno de 2003. Resultados: Entre Abril y Septiembre, se atendieron 3.701 consultas por neumonía comunitaria del adulto, 73 por ciento en los servicios de urgencia y 27 por ciento en los consultorios de atención primaria. El 14 por ciento de los episodios de NAC requirieron hospitalización en el área de Viña del Mar y 21 por ciento en el área de Quillota. Se examinó una cohorte prospectiva de 229 adultos inmunocompetentes con NAC (+/ - DE = 56 +/ - 21 años de edad) de bajo riesgo y manejo ambulatorio según las recomendaciones de la Sociedad Chilena de Enfermedades Respiratorias, quienes fueron atendidos en los hospitales de Quillota, Viña del Mar y Limache durante el período de otoño-invierno. El 40 por ciento de los episodios correspondieron a NAC tipo I y 60 por ciento a NAC tipo II. Los pacientes con NAC tipo I fueron manejados con Claritromicina (67,4 por ciento) o Amoxicilina (32,6 por ciento) y los pacientes con NAC tipo II fueron manejados con Amoxicilina-Acido clavulánico (74,5 por ciento) o Levofloxacina (24,8 por ciento) durante 10 días. El 98,7 por ciento de los casos evolucionaron favorablemente sin requerir hospitalización, y sólo tres pacientes fueron admitidos al hospital debido a fracaso del tratamiento ambulatorio. Los tres pacientes fallecieron debido a la infección pulmonar y/o descompensación de una comorbilidad (1,3 por ciento). Conclusión: La mayoría de los enfermos con NAC, sin criterios de gravedad, pueden ser manejados en el medio ambulatorio con bajos índices de hospitalización, riesgo de complicaciones y muerte.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Assistência Ambulatorial , Pneumonia Bacteriana/epidemiologia , Pneumonia Bacteriana/tratamento farmacológico , Antibacterianos/uso terapêutico , Interpretação Estatística de Dados , Chile/epidemiologia , Estudos de Coortes , Evolução Clínica , Hospitalização , Infecções Comunitárias Adquiridas/epidemiologia , Infecções Comunitárias Adquiridas/tratamento farmacológico , Resultado do Tratamento , Serviços Médicos de EmergênciaRESUMO
Background: There is limited information about the effectiveness of the treatment of community-acquired pneumonia (CAP) in Chilean emergency rooms. Aim: To assess the treatment of CAP in emergency rooms at the Viña del Mar Health Service in Chile. Material and methods: Prospective study of immunocompetent adult patients consulting for a CAP in emergency rooms. Those that required hospital admission were considered ineligible. The initial clinical and laboratory assessment, antimicrobial treatment and their condition after 30 days of follow up, were recorded. Results: Three hundred eleven adult patients aged 57±22 years (152 males), were evaluated. Patients with class I CAP (40% of cases) were treated with Clarithromycin (71.8%) or Amoxicillin (26.6%) for 10 days. Patients with class II CAP (60%) were treated with Amoxicillin-clavulanate (80.7%) or Levofloxacin (18.2%) for 10 days. Three hundred eight patients (99%) were cured without need of hospital admission; three patients (1%) were subsequently hospitalized because of clinical failure of ambulatory treatment. Overall, three patients (1%) died; all deaths occurred during or immediately after hospitalization and were related to the severity of lung infection but not to the choice of antibiotic treatment. Conclusions: The outpatient management of CAP by general practitioners working at emergency rooms was clinically effective with low rates of hospital admission and mortality.