[Community-acquired pneumonia referred for hospital management. Its epidemiology and the diagnostic and therapeutic approaches].
OBJECTIVE
To determine the epidemiology of community-acquired pneumonia referred to the hospital and to characterize the diagnostic and therapeutic approach adopted by physicians.


METHODS
Retrospective epidemiological and descriptive clinical study based on case histories consistent with a diagnosis of community-acquired pneumonia (Fang et al. Medicine, 1990; 69:307-16) of patients referred to hospitals in Soria (Spain) over a period of one year. The patients were grouped by severity and the presence of risk factors for unusual etiology. Initial approaches were compared to those advocated by various sources.


RESULTS
Three hundred eight cases of community-acquired pneumonia were diagnosed, and 82% of the patients were admitted. Mean age was 68 +/- 26 years (43% over 80 years of age). Men accounted for 56%. Two hundred seventeen patients (70%) were classified as seriously ill, 203 (66%) had risk factors for unusual etiology, and 166 (54%) were classified in both categories. Mortality among admitted patients was 13%. Etiological diagnoses did not correspond to the guidelines of the Spanish Society of Pneumology and Chest Surgery (SEPAR), with microbial identification achieved in 5%. Empirical treatment followed SEPAR guidelines in 45% of the cases. The Mensa guidelines were followed in 23% and the Sanford guidelines in 20%.


CONCLUSIONS
The incidence of community-acquired pneumonia in this population is 3.2 cases per 1,000 inhabitants/year. The population is mainly elderly and comorbidity is common, although mortality is low. We believe common criteria should be adopted for managing community-acquired pneumonia and that empirical treatment should be directed toward germs identified in each setting, based on appropriate etiological investigation.
Servicio de Medicina Interna, Hospital General de Soria.
J A
JA
Carretero Gracia
T
T
Nebreda Mayoral
A I
AI
Acereda Ridruejo
Y
Y
Larumbe Sola
M A
MA
Martínez Gutiérrez
C
C
Tierno Sanquirico
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D002648:Child; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology