Utilidad de la proteína C reactiva sérica en el diagnóstico y tratamiento del adulto inmunocompetente hospitalizado por neumonía adquirida en la comunidad / Immunocompetent adults hospitalized for a community-acquired pneumonia: Serum C-reactive protein as a prognostic marker

Background: C-reactive protein (CRP) is used to monitor patients' response during treatment of infectious diseases. Morbidity and mortality associated with community-acquired pneumonia (CAP) is high, particularly in hospitalized patients. Better risk prediction during hospitalization could improve management and ultimately reduce mortality rates. Aim: To evaluate CRP measured at admission and the third day of hospitalization as a predictor for adverse events in CAP. Material and Methods: A prospective cohort study of adult patients hospitalized with CAP at an academic hospital. Major adverse outcomes were admission to ICU, mechanical ventilation, prolonged hospital length of stay, hospital complications and 30-day mortality. Predictive associations between CRP (as absolute levels and relative decline at third day) and adverse events were analyzed. Results: Eight hundred and twenty-three patients were assessed, 19% were admitted to ICU and 10.6% required mechanical ventilation. The average hospital stay was 8.8 ± 8.2 days, 42% had nosocomial complications and 8.1% died within 30 days. Ninety eight percent of patients had elevated serum CRP on admission to the hospital (18.1 ± 14.1 mg/dL). C-reactive protein measured at admission was associated with the risk of bacterial pneumonia, bacteremic pneumonia, septic shock and use of mechanical ventilation. Lack of CRP decline within three days of hospitalization was associated with high risk of complications, septic shock, mechanical ventilation and prolonged hospital stay. Conclusions: CRP responses at third day of hospital admission was a valuable predictor of adverse events in hospitalized CAP adult patients.

Evaluación de los índices predictores de eventos adversos en el adulto inmunocompetente hospitalizado por neumonía adquirida en la comunidad / Adverse event prediction in immunocompetent adult patients hospitalized with community-acquired pneumonia

Background: Community-acquired pneumonia (CAP) causes significant morbidity and mortality in adults. Aim: To compare the accuracy of four validated rules for predicting adverse outcomes in patients hospitalized with CAP. Patients and Methods: We compared the pneumonia severity index (PSI), British Thoracic Society score (CURB-65), SMART-COP and severe CAP score (SCAP) in 659 immunocompetent adult patients aged 18 to 101 years, 52% male, hospitalized with CAP. Major adverse outcomes were: admission to ICU, need for mechanical ventilation (MV), in-hospital complications and 30-day mortality. Mean hospital length of stay (LOS) was also evaluated. The predictive indexes were compared based on sensitivity, specificity, and area under the curve of the receiver operating characteristic curve. Results: Of the studied patients, 77% had comorbidities, 23% were admitted to the intensive care unit and 12% needed mechanical ventilation. The rate of all adverse outcomes and hospital LOS increased directly with increasing PSI, CURB-65, SMART-COP and SCAP scores. The sensitivity, specificity and area under the curve of the prognostic indexes to predict adverse events were: Admission to ICU (PSI: 0.48, 0.84 and 0.73; SMART-COP: 0.97, 0.23 and 0.75; SCAP: 0.57, 0.81 and 0.76); use of MV (PSI: 0.44, 0.84 and 0.75; SMART-COP: 0.96, 0.35 and 0.84; SCAP: 0.53, 0.87 and 0.78); 30-days mortality (PSI: 0.45, 0.97 and 0.83; SMART-COP: 0.94, 0.29 and 0.77; SCAP: 0.53, 0.95 and 0.81). CURB-65 had a lower discriminatory power compared to the other indices. Conclusions: PSI score and SCAP were more accurate and specific and SMART-COP was more sensitive to predict the risk of death. SMART-COP was more sensitive and SCAP was more specific in predicting the use of mechanical ventilation.

Hospitalización diurna como modelo de atención de salud en pacientes adultos inmunocompetentes con neumonía adquirida en la comunidad / Respiratory day hospital care for immunocompetent adult patients with community-acquired pneumonia

Background: Day hospitals can reduce health care costs without increasing the risks of patients with lower respiratory tract infection. Aim: To report the experience of a respiratory day hospital care delivered to adult patients with community-acquired pneumonia (CAP) in a public hospital. Material and Methods: During the fall and winter of 2011 and 2012, adult patients with CAP of intermediate risk categories were assessed in the emergency room, their severity was stratified according to confusion, respiratory rate, blood pressure, 65 years of age or older (CRB-65) score and the Chilean CAP Clinical Guidelines, and were admitted to the respiratory day hospital. Results: One hundred seventeen patients aged 67 ± 16 years, (62% females) with CAP were attended in the respiratory day hospital. Ninety percent had comorbidities, especially chronic obstructive pulmonary disease in 58%, heart disease in 32%, diabetes in 16% and asthma in 13%. Their most important risk factors were age over 65 years in 60%, comorbidities in 88%, failure of antibiotic treatment in 17%, loss of autonomy in 21%, vital sign abnormalities in 60%, mental confusion in 5%, multilobar CAP in 23%, pleural effusion in 15%, hypoxemia in 41% and a serum urea nitrogen over 30 mg/dL in 16%. Patients stayed an average of seven days in the day hospital with oxygen, hydration, chest physiotherapy and third-generation cephalosporins (89%) associated with quinolones (52%) or macrolides (4%). Thirteen patients required noninvasive ventilation, eight patients were hospitalized because of clinical deterioration and three died in hospital. Conclusions: Day hospital care reduced hospital admission rates of patients with lower respiratory tract infections.

Incidencia de la gripe y neumonia en un grupo de ancianos institucionalizados vacunados y no vacunados en el municipio de Chia, Cundinamarca / Incidence of common cold and pneumonia an a groups of elderly institucionalized vaccinated and no vaccinated group in Chia- Cundinamarca

Los programas de inmunización contra la enfermedades del tracto respiratorio aplicados a la población infantil y recientemente a la población geriátrica han mostrado una disminución tanto en la incidencia como en la prevalencia de enfermedades infecciosas prevenibles. El propósito de este estudio fue probar la eficacia de la vacuna Imovax Gripe y Neumo 23 del Laboratorio Specia División Pasteur Merieux en la prevención de la gripe y neumonía en los adultos. Se diseñó una ficha para la recolección de datos que nos permitió obtener las VdridbkS analizadas en el estudio. La población del estudio la conformaron los integrantes de tres hogares de ancianos de la localidad de Chía, Cundinamarca. Aplicamos la vacuna a 143 pacientes en dos hogares de ancianos, siendo éstos el grupo experimental y 52 de la Fundación La Manuelita de Cajicá, no vacunados se constituyeron en el grupo control. Observamos que la incidencia de gripe en los vacunados fue de 11 por ciento y la de neumonía de 0.7 por ciento mientras que en la población no vacunada se encontró una incidencia de gripe de 40 por ciento y de neumonía de 13 por ciento . Encontramos que la incidencia de gripe y neumonía disminuye en la población vacunada y se observó la dependencia entre el contacto con la enfermedad y el desarrollo de la gripe para la población del estudio

Epidemiología de las afecciones agudas de las vías respiratorias / Epidemiology of acute respiratory diseases

En breve y somera descripción se analizan los principales factores y circunstancias que determinan la fisionomía epidemiológica en pediatría, de las afecciones acudas de las vías respiratorias, señalándose su importancia en relación con la morbilidad que presentan en México, dentro de las diversas edades de la infancia (recién nacidos, lactantes, prescolares, escolares y adolescentes). Especial referencia se hace sobre la relación que existe entre la desnutrición y las infecciones, los mecanismos inmunitarios de defensa del organismo ante los agentes agresores, así como la influencia indudable que la contaminación atmosférica, el estado de vivienda, los cambios climáticos y ciertos hábitos y costumbres como el tabaquismo, tienen la aparición y curso de estos padecimientos, al igual que la interacción de los distintos gérmenes (virus, bacterias, micoplasmas, hongos y protozoatios) que actúan como agentes causales de los mismos y de sus complicaciones y secuelas.