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Eur J Clin Microbiol Infect Dis ; 35(3): 489-95, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26753994

RESUMO

We investigated the positivity rate, the detection rates for non-covered pathogens and the therapeutic impact of microbiological samples (MS) in community-acquired pneumonia (CAP), nursing home-acquired pneumonia (NHAP) and hospital-acquired pneumonia (HAP) in elderly hospitalised patients. Patients aged 75 years and over with pneumonia and hospitalised between 1/1/2013 and 30/6/2013 in the departments of medicine (5) and intensive care (1) of our university hospital were included. Microbiological findings, intra-hospital mortality and one-year mortality were recorded. Among the 217 patients included, there were 138 CAP, 56 NHAP and 23 HAP. MS were performed in 89.9, 91.1 and 95.6 % of CAP, NHAP and HAP, respectively. Microbiological diagnosis was made for 29, 11.8 and 27.3 % of patients for CAP, NHAP and HAP, respectively (p = 0.05). Non-covered pathogens were detected for 8 % of CAP, 2 % of NHAP and 13.6 % of HAP (p = 0.1). The antimicrobial spectrum was significantly more frequently reduced when the MS were positive (46.7 % vs. 10.8 % when MS were negative, p = 10(-7)). The MS positivity rate was significantly lower in NHAP than in CAP and HAP. MS revealed non-covered pathogens in only 2 % of NHAP. These results show the poor efficiency and weak clinical impact of MS in the management of pneumonia in hospitalised older patients and suggest that their use should be rationalised.


Assuntos
Infecções Comunitárias Adquiridas/diagnóstico , Infecções Comunitárias Adquiridas/microbiologia , Infecção Hospitalar/diagnóstico , Infecção Hospitalar/microbiologia , Pneumonia/diagnóstico , Pneumonia/microbiologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Anti-Infecciosos/uso terapêutico , Infecções Comunitárias Adquiridas/mortalidade , Infecções Comunitárias Adquiridas/terapia , Infecção Hospitalar/mortalidade , Infecção Hospitalar/terapia , Gerenciamento Clínico , Feminino , Mortalidade Hospitalar , Hospitalização , Hospitais , Humanos , Masculino , Casas de Saúde , Pneumonia/mortalidade , Pneumonia/terapia , Estudos Retrospectivos , Índice de Gravidade de Doença , Resultado do Tratamento
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