Neumonía neumocócica adquirida en la comunidad en adultos hospitalizados / Community acquired pneumococcal pneumonia in hospitalized adult patients

ABSTRACT

BACKGROUND: S pneumoniae is the most common cause of community-acquired pneumonia. AIM: To evaluate the clinical characteristics, antibiotic resistance, management and prognostic factors in pneumococcal pneumonia. METHODS: Prospective evaluation in 46 adults (age +/- sd 68 +/- 17 years) hospitalized with pneumococcal pneumonia confirmed by sputum, blood or pleural fluid cultures. Clinical and radiographic variables, risk factors for antibiotic resistance, and hospital mortality rate were recorded. RESULTS: Heart disease (39 per cent), COPD/asthma (25 per cent), and diabetes mellitus (18 per cent) were the most frequent underlying diseases. None of the patients had previously received pneumococcal vaccine. Only 17 per cent of the patients had the classic triad of chills, fever and productive cough. At admission, interestingly, 17 per cent presented with congestive heart failure. Resistance of pneumococci to penicillin, cefotaxime or erythromycin was 15 per cent, 6 per cent and 11 per cent, respectively. Antibiotic use prior to admission was significantly associated with antibiotic resistance (OR = 6; CI 95 per cent = 1.1-32; p < 0.05). Fifty per cent of the patients were admitted to intermediate or intensive care units, 15 per cent were mechanically ventilated, 20 per cent developed septic shock, 20 per cent developed acute renal failure and 13 per cent died in the hospital. Clinical factors significantly associated with higher mortality were systolic hypotension (< or = 90 mmHg), ICU admission and BUN > 30 mg per dL. CONCLUSIONS: Our data suggest that pneumococcal pneumonia is still a severe infection with high mortality; hence, efforts should be made at prevention using pneumococcal immunization.