Initial hospital management at emergency departments of community-acquired pneumonia in Spain

Abstract number: 1733_680

Alvarez-Rodriguez V., Martinez D., Gimenez M.J., Barberan J., Aguilar L., Ruiz-Polaina M.J., Prieto J.

Objectives: To study the initial management of patients with community-acquired pneumonia (CAP) admitted to hospital through Emergency departments.

Methods: Clinical records of patients with ≥ 14 years of age and CAP diagnosis admitted to hospital through Emergency departments in a three-month period (January–March 2003) in 24 Spanish hospitals were retrospectively reviewed in order to obtain demographic data, clinical and analytical data necessary to classify them according to the Pneumonia Severity Index (PSI) category, comorbidity data, microbiological diagnostic tests performed, initial antibiotic treatment and outcome. Patients sent for treatment on an ambulatory basis were excluded from the study.

Results: 341 patients (67.0 ± 24.6 years; 65.3% males) were admitted to hospital trough the Emergency department: 24.0% were managed at Short Stay Medical Units (SSMU), 36.4% at Internal Medicine, 30.2% at Pneumology, 1.7% at Intensive Care Units (ICU), 2.1% at Infectious Diseases and 5.6% were derived to a different hospital. Patients in high-risk classes (IV-V) were 65.7%, 14.7% were class III and 19.6% were classes I-II. Blood culture was performed in 50.1% patients (41% patients class I-III, 53.8% patients class IV, and 56.2% patients class V), while sputum culture was performed in 35.8% patients (39.3% patients class I-III, 36.1% patients class IV, and 31.4% patients class V). Pneumococcal or Legionella urinary antigen detection was performed in 34% and 42.2%, respectively. Most frequent comorbidities were: chronic obstructive airway disease (37.2% patients), heart disease (24.6%), hypertension (17%), diabetes (10.8%), and malignancies (10%). Initial treatment was fluoroquinolone in 37.5% patients, 3rd generation cephalosporin + macrolide in 19.4%, amoxicillin/clavulanic acid in 17.9%, amoxicillin/clavulanic acid + macrolide in 7.0%, 3rd generation cephalosporin in 5.0%, macrolides in 4.7%, and others in 8.5%. Eleven patients died (3.2%), 100% of them within the high-risk class IV-V.

Conclusions: Microbiological diagnostic tests may be scarcely used. As severity increased, request of blood culture increased but of sputum culture decreased. Most frequent treatments applied were fluoroquinolones as monotherapy followed by 3rd generation cephalosporin + macrolide or amoxicillin/clavulanic acid. These empirical treatments may reflect resistance rates in Streptococcus pneumoniae in Spain, and/or coverage of both typical and atypical aetiologies.