Community-acquired pneumonia: clinical course and management
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StatusThe thesis was presented on the 30 May, 2007Approved by NCAA on the 20 September, 2007 Abstract – 0.28 Mb / in romanianThesisCZU 616.24 – 002 + 614.2
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Keywords
community-acquired pneumonia, etiologic diagnosis, etiologycal agent, atypical pathogens, mixed infections, chest x-ray, interstitial, alveolar consolidation, prognostic factors, resolution slowly resolvingSummary
The present study prospectively studied 275 consecutive nonimmunocompromised patients admitted to the hospital for non-severe (53%) and severe (47%) community-acquired pneumonia (CAP). CAP occurs most commonly in smokers (26%), persons with history of excess alcohol (14%), with comorbidity (62%). A constellation of symptoms considered classical for CAP (acute onset+fever+cough+pleuritic chest pain) was present în 44% cases, and consolidation on fisical examination – in 22% cases. Patients with productive cough, pleuritic chest pain, consolidation on fisical examination, and alveolar consolidation on radiography were more likely to have pneumococcal pneumonia. Radiographic features of interstitial consolidation and multisystem clinical involvement were more suggestive for CAP with atypical pathogens. However the likely etiologycal agent causing CAP cannot be accurately predicted from clinical features.
Using noninvasive diagnostic techniques we obtained an etiologic diagnosis in 60% of cases. It was definite in 9% cases and presumptive in 51% cases. The most frecquent pathogen were atypical pathogens (M.pneumoniae (17%), C.pneumoniae (17%), Legionella pn. (17%)) and S.pneumoniae (12%), followed by M.catarrhalis (7%), S. ß-haemolitic (6%), Staph. aureus (6%), K.pneumoniae (4,8%). Mixed infections were present in 19% cases. In the group of nonsevere CAP etiology was determined in 56% cases, the most important pathogen was M.pneumoniae (18%). In the group of severe CAP etiological agents were found in 65% cases, the most important were S.pneumoniae (17%) and Staph. aureus (11%). In multivariate analysis alcohol abuse, renal failure, hyperglycemia (≥11 mmol/l), cardiac failure, inappropriate antimicrobial treatment were independent factors related to severity of pneumonia. The hostpital mortality for the entire cohort was 10%: 0,7% in the group with nonsevere CAP and 21% - with severe CAP. Independent prognostic factors for death were: altered mental status, renal failure, hypothermia, tachycardia, alcohol abuse, pulmonary suppuration, new infiltrate on chest x-ray. Fever was identified as protective factor against adverse outcome. Radiographic resolution of CAP occurs within 4 weeks in 70% cases, 14% patients had resolution after 8-12 weeks. Multilobar pulmonary involvement, mixed infections, pleural effusion and progressive infiltrares on chest x-ray were independently associated with slowly resolving pneumonia.
Oficial Reviewers
- Dumitru Sain
doctor habilitat, professor, Public Medical Sanitary Intitution Institute of Phthisiopneumology "Chiril Draganiuc" - Sergiu Matcovschi
doctor habilitat, professor, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova
Theses
