Community-acquired pneumonia: aetiologic changes in a limited geographic area. An 11-year prospective study.

The aim of this study is to describe the changes in the aetiology of hospitalised patients with community-acquired pneumonia (CAP) during an 11-year observational period in a limited geographic area. Eight hundred and one (801) adult patients with CAP hospitalised were included. The patients were divided into three groups according to the time of presentation. Comprehensive microbiological laboratory tests were performed and differences in aetiology were analysed. In 228 patients (31%), a pathogen was detected, with Coxiella burnetii being the most common (20.1%). Significant variations in the prevalence of Chlamydophila pneumoniae were found between groups but not in other pathogens. In conclusion, long-term epidemiological studies may contribute to the knowledge of actual CAP aetiology.

[Community-acquired pneumonia: influence of the duration of intravenous antibiotic therapy on hospital stay and the cost-benefit ratio]. / Neumonía adquirida en la comunidad: influencia de la duración de la antibioterapia intravenosa en la estancia hospitalaria y relación coste/efectividad.

UNLABELLED: Intravenous antibiotic therapy (IVAT) is usually prescribed for patients hospitalized with community-acquired pneumonia (CAP). Studies have associated prolonged IVAT with longer hospital stays and higher costs. The aim of this study was to determine the factors that influence the expense generated by and mean stay of patients hospitalized for pneumonia, with special attention to the influence of IVAT duration. MATERIAL AND METHODS: One hundred twenty-five CAP patients admitted to the respiratory medicine wards of our hospital were randomly assigned to five different staff physicians. IVAT was prescribed following the norms of the Spanish Society of Respiratory Medicine and Chest Surgery (SEPAR). IVAT was withdrawn when the attending physician considered it appropriate. We collected epidemiological, comorbidity, clinical and analytical data. Complications were recorded and severity of CAP was classified using the model proposed by Fine. Follow-up care was given at an outpatient clinic until symptoms disappeared and chest films resolved. Multivariate analysis determined the factors predicting mean hospital stay and high cost. Costs were calculated based on data issued by the billing department. RESULTS: The mean cost of care was 307,274 pesetas, mean duration of IVAT was 5.8 days and mean hospital stay was 9.4 days. Multivariate analysis showed that cost was related to mean hospital stay and IVAT. Mean hospital stay was associated with IVAT, the presence of respiratory insufficiency and the day of the week when admission took place (with weekend admission leading to longer stays). CONCLUSIONS: The duration of IVAT in CAP influences mean hospital stay and cost, without adding any evident therapeutic benefit (in the group of patients selected). Recommendations for diagnosing and treating CAP may be advisable.

Neumonía adquirida en la comunidad: influencia de la duración de la antibioterapia intravenosa en la estancia hospitalaria y relación coste/efectividad / Community-acquired pneumonia: influence of the duration of intravenous antibiotic therapy on hospital stay and the cost-benefit ratio

Durante el ingreso hospitalario de los pacientes con una neumonía adquirida en la comunidad (NAC) es práctica clínica habitual el empleo de antibioterapia intravenosa (ABIV) durante un período de tiempo no determinado. Diversos estudios han relacionado la prolongación de la ABIV con una mayor estancia media y costes del proceso asistencial. El objetivo de nuestro estudio fue determinar los factores que influyen en el coste económico y en la estancia media de la neumonía que precisa hospitalización, con especial atención a la influencia que la duración de la ABIV tendría en ellos. MATERIAL Y MÉTODOS: Se estudiaron 125 casos de NAC ingresados en la sección de neumología de nuestro hospital, atendidos al azar por cinco médicos distintos de la plantilla. La ABIV se indicó siguiendo la normativa de la SEPAR y se retiró cuando el facultativo responsable lo estimó oportuno. Se recogieron datos epidemiológicos, comorbilidad y datos clínicos y analíticos. Se valoraron complicaciones, y la gravedad de la NAC se clasificó con el modelo propuesto por Fine. Los pacientes fueron seguidos de forma ambulatoria hasta su curación clínica y resolución radiológica. Se realizaron análisis estadísticos multivariados para determinar los factores predictores de estancia media y costes económicos elevados. Los costes se elaboraron a partir de los datos emitidos por el servicio de facturación. RESULTADOS: El coste medio del proceso fue de 307.274 pesetas, la duración media de ABIV, de 5,8 días y la estancia media, de 9,4 días. En el análisis multivariado, el coste económico guardó relación con la estancia media y la duración de ABIV, y por su parte, la estancia media se asoció con la ABIV, la presencia de insuficiencia respiratoria y el día de la semana en que se producía el ingreso (mayor estancia en los ingresos de fin de semana). CONCLUSIONES: La duración de la antibioterapia intravenosa en la NAC influye sobre la estancia media y el coste económico del proceso, sin añadir aparentemente beneficios terapéuticos (en grupos de pacientes seleccionados). Tal vez sería conveniente incluir algunas recomendaciones sobre este punto en futuras normativas sobre diagnóstico y tratamiento de la NAC (AU)

[Acute pulmonary toxicity caused by carbamazepine: apropos of a case]. / Toxicidad pulmonar aguda por carbamazepina: a propósito de un caso.

Pulmonary toxicity caused by carbamazepine seems to be a non dose-dependent process involving pulmonary infiltrates, eosinofilia and skin rash. We report a case with acute presentation that resolved successfully after the drug was withdrawn and the patient was treated with corticosteroids. Bronchoalveolar lavage showed an inversion of the lymphocyte ratio CD4/CD8 supporting the suggestion by other authors that drug-induced pulmonary toxicity.