Rev Esp Quimioter 2018; 31(2): 186-202

Recommendations for the care of patients with community-acquired pneumonia in the Emergency Department

AGUSTÍN JULIÁN-JIMÉNEZ, INMACULADA ADÁN VALERO, ALICIA BETETA LÓPEZ, LUIS MIGUEL CANO MARTÍN, OLGA FERNÁNDEZ RODRÍGUEZ, RAFAEL RUBIO DÍAZ, Mª ANTONIA SEPÚLVEDA BERROCAL, JUAN GONZÁLEZ DEL CASTILLO, FRANCISCO JAVIER CANDEL GONZÁLEZ Y EN NOMBRE DEL GRUPO NAC (NEUMONÍA ADQUIRIDA EN LA COMUNIDAD) DEL GRUPO INFECCIONES EN URGENCIAS-CÓDIGO SEPSIS DE LA RED DE EXPERTOS Y PROFESIONALES DE URGENCIAS DEL SESCAM (SERVICIO DE SALUD DE CASTILLA LA MANCHA) Y DE INFURG-SEMES (GRUPO DE TRABAJO DE INFECCIONES DE LA SOCIEDAD ESPAÑOLA DE MEDICINA DE URGENCIAS Y EMERGENCIAS)

The incidence of community-acquired pneumonia (CAP) ranges from 2-15 cases / 1,000 inhabitants / year, being higher in those older than 65 years and in patients with high co-morbidity. Around 75% of all CAP diagnosed are treated in the Emergency Department (ED). The CAP represents the main cause for sepsis and septic shock in ED, and the most frequent cause of death and admission to the Intensive Care Unit (ICU) due to infectious disease. Overall mortality is 10-14% according to age and associated risk factors. Forty to 60% of CAP will require hospital admission, including observation units (with very variable ranges from 22-65% according to centers, seasonal of the year and patients´ characteristics). Between the admissions, 2-10% will be in the ICU. All of previously mentioned reflects the importance of the CAP in the ED, as well as the “impact of the emergency care on the patient with CAP”, as it is the establishment where the initial, but key decisions, are made and could condition the outcome of the illness.
It is known the great variability among physicians in the diagnostic and therapeutic management of CAP, which is one of the reasons that explains the great differences in the admission rates, achievement of the microbiological diagnosis, request for complementary studies, the choice of antimicrobial treatment, or the diversity of applied care. In this sense, the implementation of clinical practice guidelines with the use of the severity scores and the new tools available, such as biomarkers, can improve patient care with CAP in ED. Therefore, a multidisciplinary group of emergency professionals and specialists involved in the care process of CAP has designed a guideline with several recommendations for decisions-making during the key moments in patients with CAP attended in the ED.

Rev Esp Quimioter 2018; 31(2): 186-202 [Texto completo PDF]