title: The management of pneumonia in internal medicine.
abstract: Pneumonia generates a high workload for internal medicine departments. Management of this disease is challenging, because patients are usually elderly and have multiple comorbid conditions. Furthermore, the interpretation and adherence to guidelines are far from clear in this setting. We report the opinion of 43 internists especially interested in infectious diseases that were questioned at the 2011 XXXII National Conference of Spanish Society of Internal Medicine about the main issues involved in the management of pneumonia in the internal medicine departments, namely, classification, admission criteria, microbiological workup, therapeutic management, discharge policy, and prevention of future episodes. Participants were asked to choose between 2 options for each statement by 4 investigators. Consensus could not be reached in many cases. The most controversial issues concerned recognition and management of healthcare-associated pneumonia (HCAP). Most participants were aware of the differences in terms of underlying diseases, etiological distribution, and outcome of HCAP compared with community-acquired pneumonia, but only a minority agreed to manage HCAP as hospital-acquired pneumonia, as suggested by some guidelines. A clinical patient-to-patient approach proved to be the option preferred by internists in the management of HCAP.
authors.affiliation: Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Palma de Mallorca, Spain; Universidad Complutense de Madrid, Madrid, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Bouza
authors.affiliation: 2nd Division of Infectious Diseases, National Institute for Infectious Diseases Lazzaro Spallanzani, Rome, Italy. Electronic address: maddalena.giannella@libero.it.
authors.forename: M
authors.initials: M
authors.lastname: Giannella
authors.affiliation: Department of Internal Medicine, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: B
authors.initials: B
authors.lastname: Pinilla
authors.affiliation: Department of Internal Medicine, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: R
authors.initials: R
authors.lastname: Pujol
authors.affiliation: Department of Internal Medicine, Hospital de Mataró, Mataró, Barcelona, Spain.
authors.forename: J A
authors.initials: JA
authors.lastname: Capdevila
authors.affiliation: Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Palma de Mallorca, Spain; Universidad Complutense de Madrid, Madrid, Spain.
authors.forename: P
authors.initials: P
authors.lastname: Muñoz
keywords: Community-acquired pneumonia; Healthcare-associated pneumonia; Hospitalized pneumonia patient; Internal medicine; Medicina interna; Neumonía adquirida en la comunidad; Neumonía asociada a la asistencia sanitaria; Paciente hospitalizado con neumonía