Avaliação dos critérios de internação e mortalidade de pacientes com pneumonia adquirida na comunidade admitidos no Hospital das Clínicas da UFMG no período de 2005 a 2007

Abstract

Background: The community-acquired pneumonia (CAP) is a common disease and an important cause of hospitalization and mortality, responsible for a large amount of resources in its treatment. The lack of knowledge about national guidelines for the treatment of this disease and / or decision regarding the hospitalization of patients with CAP based on clinical judgment, may contribute for the maintenance of the high percentage of hospitalizations, with a consequent increase in costs and morbidity. Objectives: The aim of this study was to analyze, retrospectively, the criteria for hospitalization of patients with CAP in the Hospital das Clínicas of the Universidade Federal de Minas Gerais (HC / UFMG) between 2005 and 2007, comparing the 30- day mortality observed in this period to that provided by current criteria recommended by the Sociedade Brasileira de Pneumologia e Tisiologia (SBPT), assess the adequacy of antimicrobial therapy instituted regarding the guidelines recommendations, length of hospital stay, need for admission to the intensive care unit (ICU) and mechanical ventilation (VM). Also, to investigate the survival at 12 months, percentage of microbiological isolation and incidence of complications. Methodology: A observational, retrospective study that included patients over 18 years, hospitalized with a diagnosis of CAP from January 2005 to December 2007, in the HC / UFMG. Medical records and chest radiographs were reviewed. Results: A hundred and twelve patients were included, 82 (73.2%) and 66 (58.9%) had admission criteria and antibiotic therapy concordant, respectively, with the SBPT guidelines. Mean age was 57.34 years and 30-day and 12 months mortalities rates were 12.3% (n = 13) and 19.4% (n = 20), respectively. According with CRB-65 classes (0, 1-2, 3-4), only those classified as 1-2 had a significant reduction in shortterm mortality when treated in accordance with the guidelines. Variables independently associated with 30-day mortality were guideline-concordant antibiotic therapy, as a protective factor, (RR = 0.85, 95% CI = 0.76 to 0.96, p = 0.00) and cerebrovascular disease (RR = 1.3 , 95% CI = 1.11 to 1.53, p = 0.00). No significant association was found between reduction of length of stay or complications and adherence to guidelines. Etiological investigation was performed in 32 patients (28.6%) with microbiological isolation in only four cases (3.6%). Conclusion: The hospitalization of patients with CAP in the HC / UFMG was consistent with that stated by the Brazilian guidelines in most cases. The guideline-concordant antibiotic therapy was associated with lower 30-day mortality in patients classified as CRB-65 1-2. The percentage of guideline-concordant antibiotic therapy, and especially the microbiological investigation was low justifying local initiatives to improve patient care affected by this disease.