RESUMEN
Resumen La neumonía sigue siendo una de las principales causas de consulta y de hospitalización a la que, además de su un alto impacto en términos de morbilidad y mortalidad, se suma la actual problemática de resistencia a los antimicrobianos, por lo que establecer directrices que permitan su adecuado diagnóstico y tratamiento es de gran importancia para obtener mejores desenlaces clínicos y promover un uso racional de antibióticos en estos pacientes. La presente guía de práctica clínica (GPC) contiene recomendaciones basadas en la evidencia para el diagnóstico y tratamiento de la neumonía adquirida en la comunidad en adultos, las cuales fueron realizadas mediante el proceso de adaptación de GPC basadas en la evidencia para el contexto colombiano.
Abstract Pneumonia continues to be one of the main causes of consultation and hospitalization to which, besides its high impact on morbidity and mortality, the current problem of antimicrobial resistance is added; thus, establishing guidelines that allow its adequate diagnosis and treatment is of great importance to obtain better clinical outcomes and promote a rational use of antibiotics in these patients. This clinical practice guideline (CPG) contains evidence-based recommendations for the diagnosis and treatment of community-acquired pneumonia in adult population; these recommendations were made by means of the process of adaptation of evidence-based CPGs for the Colombian context.
RESUMEN
Patients with autoimmune diseases (ADs) are a challenge for the intensivist; it is hard to differentiate among infection, disease activity, and combinations of both, leading to high mortality. This study is a retrospective analysis of 124 critically ill patients admitted to the intensive care unit (ICU) in a university hospital between 2008 and 2016. Bivariate case-control analysis was performed, using patients who died as cases; later, analysis using a logistic regression model with variables that were associated with mortality was conducted. Four variables were consistently associated with mortality in the logistic regression model and had adequate prediction value (Hosmer and Lemeshow statistic = 0.760; Nagelkerke R-squared = 0.494). The risk of death was found to be statistically associated with the following: shock at admission to ICU [odds ratio (OR): 7.56; 95% confidence interval (CI): 1.78-31.97, p = 0.006], hemoglobin level <8 g/dL (OR: 16.12; 95% CI: 3.35-77.52, p = 0.001), use of cytostatic agents prior to admission to the ICU (OR: 8.71; 95% CI: 1.23-61.5, p = 0.03), and low levels ofcomplement C3 (OR: 5.23; 95% CI: 1.28-21.35, p = 0.02). These variables can guide clinicians in the early identification of patients with AD with increased risk of death during hospitalization, leading to initial therapies seeking to improve survival. These results should be evaluated prospectively in future studies to establish their predictive power.
