Adesão a diretrizes e impacto nos desfechos em pacientes hospitalizados por pneumonia adquirida na comunidade em um hospital universitário

Abstract

Objective: To evaluate the agreement between the criteria used for hospitalization of patients with communityacquired pneumonia (CAP) and those of the Brazilian Thoracic Association guidelines, and to evaluate the association of that agreement with 30-day mortality. Secondarily, to evaluate the agreement between the treatment given and that recommended in the guidelines with length of hospital stay, microbiological profile, 12-month mortality, complications, ICU admission, mechanical ventilation, and 30-day mortality. Methods: This was a retrospective study involving adult patients hospitalized between 2005 and 2007 at the Federal University of Minas Gerais Hospital das Clínicas, located in Belo Horizonte, Brazil. Medical charts and chest X-rays were reviewed. Results:Among the 112 patients included in the study, admission and treatment criteria were in accordance with the guidelines in 82 (73.2%) and 66 (58.9%), respectively. The 30-day and 12-month mortality rates were 12.3% and 19.4%, respectively. The 30-day mortality rate was lower for patients in whom the CRB-65 (mental Confusion, Respiratory rate, Blood pressure, and age ≥ 65 years) score was 1-2 and the antibiotic therapy was in accordance with the guidelines (p = 0.01). Cerebrovascular disease and appropriate antibiotic therapy showed independent associations with 30-day mortality. There was a trend toward an association between guidelineconcordant antibiotic therapy and shorter hospital stay. Conclusions: In the population studied, admission and treatment criteria that were in accordance with the guidelines were associated with favorable outcomes in hospitalized patients with CAP. Cerebrovascular disease, as a risk factor, and guideline-concordant antibiotic therapy, as a protective factor, were associated with 30-day mortality.Keywords: Pneumonia/therapy; Pneumonia/mortality; Hospitalization; Guideline adherence. ResumoObjetivo: Avaliar a concordância entre os critérios de hospitalização utilizados para a admissão de pacientes com pneumonia adquirida na comunidade (PAC) e aqueles da Sociedade Brasileira de Pneumologia e Tisiologia e avaliar a associação dessa concordância com a taxa de mortalidade em 30 dias. Secundariamente, avaliar a associação da concordância entre o tratamento instituído e as recomendações dessas diretrizes com duração da internação hospitalar, investigação microbiológica, mortalidade em 12 meses, complicações, internação em UTI, ventilação mecânica e mortalidade em 30 dias. Métodos: Estudo retrospectivo que incluiu pacientes adultos internados entre 2005 e 2007 no Hospital das Clínicas da Universidade Federal de Minas Gerais, na cidade de Belo Horizonte (MG). Foram revisados prontuários e radiografias de tórax. Resultados: Dentre os 112 pacientes incluídos, os critérios de internação e de tratamento foram concordantes com as diretrizes em 82 (73,2%) e 66 (58,9%), respectivamente. A taxa de mortalidade em 30 dias e em 12 meses foi de 12,3% e 19,4%, respectivamente. Pacientes com escore de CRP-65 (Confusão mental, frequênci...

Community-acquired pneumonia: economics of inpatient medical care vis-à-vis clinical severity,

“…( 2 ) One major cause of the difficulties experienced in and the frequently unsatisfactory clinical outcomes of the treatment of CAP is poor adherence to clinical practice guidelines, as demonstrated in a recent study conducted in Brazil. ( 3 ) In the context of increased expectations that health care systems will deliver cost-effective care, the financial burden of CAP has attracted the attention of experts. ( 4 ) Various measures have been proposed and implemented to contain the costs related to the care of patients with CAP while preserving satisfactory clinical outcomes.…”

Clinical, epidemiological, and etiological profile of inpatients with community-acquired pneumonia in a public hospital in the interior of Brazil

“…The observed in-hospital mortality rate of 15.5% reflects the major impact of this disease, being similar to that found in other national and international studies. 25 , 26 In addition, ICU admission was required in almost one third of the cases (29.3%), which increases the impact of CAP on patients and the health care system.…”

Distribuição espacial das taxas de internação de crianças por pneumonia no Sistema Único de Saúde, nos municípios do estado de São Paulo

“…In addition, community-acquired pneumonia accounts for much of the health care costs in Brazil, as it is associated with high hospitalization rates in the country 7,8 . Although there has been a decline in child mortality due to pneumonia in recent decades, it is still a major cause of hospitalization and death in developing countries 5,[8][9][10][11] , being the disease that causes the most deaths in children up to 5 years old in the world 12 , approximately two million children according to one study 13 .…”