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.

Abstract

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.