Changes in the antibiotic scheme in community-acquired pneumonia. Sputum culture value in patients admitted to the Hospital of San José, Bogotá D.C.

Cambios del esquema antibiótico en neumonía adquirida en la comunidad. Valor del cultivo de esputo en pacientes ingresados al Hospital de San José, Bogotá D.C.

Introduction: the use of Gram and sputum culture for the management and follow-up of patients with community-acquired pneumonia (CAP) is still controversial. Objective: to describe the frequency of change of antibiotic management according to the result of sputum culture in patients hospitalized with NAC. Type of study: descriptive cross-section. Methods: patients admitted to the internal medicine service of the San José Hospital with a clinical and radiological diagnosis of NAC that did not require ICU management. We included 86 cases in a four-month period to which the CURB 65 prognostic scale was applied at admission, the presence or absence of comorbidities, the Gram positivity and sputum culture, the hospital stay and the antibiotic change according to the with the result of sputum culture if the sample was significant. Results: the average age of the population was 58.8 years (DS 21.7). 45% had comorbidities on admission and 37% had some type of complication associated with NAC. On the CURB-65 scale 52% had one point, two points 27%, three 3.5% and four 2%. The response to antibiotic therapy was observed in 85% and the frequency of antibiotic change according to the culture report occurred in 10% (6/62). The median number of days of hospital stay was five. 95% left the hospital and the remaining 5% was transferred to another service. Conclusions: Gram and sputum culture are low-cost and useful diagnostic aids in patients with CAP classified according to high-risk severity scales or severe pneumonias, where isolation of the germ is crucial to direct antibiotic therapy; in non-severe pneumonias they have not shown greater utility since there is seldom isolation of the germ and they do not generate changes in the patient's management. Adequate intake and processing must be ensured to increase the likelihood of isolation. Abbreviations: NAC, pneumonia acquired in the community; DS, standard deviation; COPD, chronic obstructive pulmonary disease; EN, neurological disease; PSI, pulmonary severity index.

1. Lionel AM, Richard GW, Anzueto A, Bartlett J, Douglas G, Nathan C, Scott F, Thomas M, Musher D, Niederman M, Torres Whitney G. Infectious Diseases Society of America / American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007 Mar 1;44 Suppl 2:S27-72

2. Niederman M, Mandell L, Anzueto A. Guidelines for the management of adults with community-acquired pneumonia diagnosis, assesment of severity, antimicrobial therapy, and prevention. Am J Resp Crit Care Med 2001 Jun; 163(7):1730-54.

3. Barlet J, Dowell S, Mandell L. Practice guidelines for the management of community-acquired pneumonia in adults. Clin Infec Dis. 2000; 31: 347-82

4. Ruiz M, Ewig S, Marcos AM. Etiology of community–acquired pneumonia: impact of age, comorbidity and severity. Am J Respir Crit Care Med. 1999; 160: 397-05.

5. Bartlett JG, Mundy LM. Community-acquired pneumonia. N Engl J Med. 1995; 333: 1618-24.

6. Jackson ML, Neuzil KM, Thompson WW, Shay DK, Yu O, Hanson CA, Jackson LA. The Burden of Community- Acquired Pneumonia in Seniors: Results of a Population-Based Study. Clin Infect Dis. 2004 Dec 1; 39(11):1642-50.

7. Feikin DR, Schuchat A, Kolczak M, et al. Mortality from invasive pneumococcal pneumonia in the era of antibiotic resistance, 1995-1997. Am J Public Health. 2000 Feb; 90(2):223-9.

8. American Thoracic Society. Guidelines for the initial management of adults with community-acquired pneumonia: diagnosis, assessment of severity, and initial antimicrobial therapy. Am Rev Respir Dis. 1993; 148: 1418-26.

9. Ewig S, Ruiz M, Torres A, Marco F, Martínez JA, Sánchez M, et al. Pneumonia acquired in the community trough drug-resistant Streptococcus pneumoniae. Am J Respir Crit Care Med. 1999; 159: 1835-42.

10. Fry AM, Shay DK, Holman RC, et al. Trends in hospitalizations for pneumonia among persons aged 65 years or older in the United States, 1988–2002. JAMA. 2005; 294(21):2712–9.

11. Hartmut M. Managing community-acquired pneumonia: a european perspective. Respir Med. 2007 Sep; 101(9):1864-73.

12. Shah PB, Giudice JC, Griesback R Jr, Morley TF, Vasoya A. The Newer Guidelines for the Management of Community-Acquired Pneumonia. J Am Osteopath Assoc. 2004 Dec; 104(12):521-6.

13. Niederman MS, McCombs JS, Unger AN, Kumar A, Popovian R. The cost of treating community-acquired pneumonia. Clin Ther. 1998; 20(4): 820–37.

14. Lim WS, Macfarlane JT. Defining prognostic factors in the elderly with community acquired pneumonia: a case controlled study of patients aged > 75 years. Eur Respir J. 2001; 17: 200-5.

15. Aujesky D, Auble TE, Yealy DM, et al. Prospective comparison of three validated prediction rules for prognosis in community-acquired pneumonia. Am J Med. 2005; 118: 384–92.

16. Capelastegui A, España PP, Quintana JM, et al. Validation of a predictive rule for the management of community-acquired pneumonia. Eur Respir J. 2006; 27: 151–7.

17. Feldman C. Pneumonia in the elderly. Clin Chest Med. 1999;20: 563–73.

18. Ruhe JJ, Hasbun R. Streptococcus pneumoniae bacteremia: duration of previous antibiotic use and association with penicillin resistance. Clin Infect Dis. 2003; 36:1132–8.

19. Riquelme R, Torres A, El-Ebiary M, et al. Community acquired pneumonia in the elderly: a multivariate analysis of risk and prognostic factors. Am J Respir Crit Care Med. 1996; 154: 1450–5.

20. Bartlett JG, Mundy LM. Current concept- community acquired pneumonia. N Engl J Med 1995; 333(24):1618-24.

21. Ravichandran T, Walid EH, Medhat I, Solis R and Anees K. Nonvalue of the initial microbiological studies in the management of nonsevere community-acquired pneumonia. Chest. 2001;119;181-84

22. Ewig S, Schlochtermeier M, Goke N, Niederman MS. Applying sputum as a diagnostic tool in pneumonia. Chest. 2002;121;1486-92.

23. Méndez R, Torres A, Rodríguez F, Zalacain R, Aspa J, Martín JJ, et al. Reaching stability in communityacquired pneumonia: the effects of the severity of disease, treatment, and the characteristics of patients. Clin Infect Dis. 2004 Dec 15;39(12):1783-90.

24. Thomas J, Marrie C, Lau Y. Wheeler SL, Wong CJ, Feagan BF. Predictors of symptom resolution in patients with community-acquired pneumonia. Clin Infect Dis. 2000 Dec;31(6):1362-7.