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Vol. 16. Issue 2.
Pages 223-235 (March - April 2010)
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Vol. 16. Issue 2.
Pages 223-235 (March - April 2010)
Artigo Original/Original Article
Open Access
Pneumonia adquirida na comunidade numa unidade de cuidados intensivos
Community-acquired pneumonia in an intensive care unit
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M. Raquel Marques1, António Nunes2, Cristina Sousa3, Fausto Moura2, João Gouveia2, Armindo Ramos4,*
1 Interna do internato Complementar de Medicina Interna/Resident, Internal Medicine
2 Assistente de Medicina Interna, Intensivista/Consultant, Internal Medicine, Intensive Care
3 Assistente Hospitalar Graduada de Gastrenterologia, Intensivista/Consultant, Gastroenterology Specialist, Intensive Care
4 Assistente Hospitalar Graduado de Medicina Interna, Intensivista e Director da Unidade de Cuidados Intensivos Médico-Cirúrgicos/Consultant, Internal Medicine Specialist, Intensive Care, Medical-Surgical Intensive Care Unit
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Resumo

A pneumonia adquirida na comunidade (PAC) é a principal causa de sépsis em cuidados intensivos de adultos. Com o objectivo de caracterizar o quadro clínico de PAC em cuidados intensivos, tratamento e avaliação de factores prognósticos, com especial relevância para a antibioterapia, realizou-se um estudo retrospectivo dos doentes admitidos numa UCI polivalente com PAC, de 1 de Junho de 2004 a 31 de Dezembro de 2006. Analisaram-se 76 doentes com uma idade média de 62,88 (18,75) anos. O APACHE II médio de 24,88 (9,75) e o SAPS 2 médio era de 51,18 (18,05), com mortalidade prevista de 47,27%. O microrganismo responsável foi identificado em 42,1% dos casos. O agente etiológico mais comum foi o Streptococcus pneumoniae, mas o grupo de agentes etiológicos mais frequentemente identificados foi o dos bacilos entéricos gramnegativos.

A antibioterapia prévia mais usada foi a levofloxacina. O esquema de antibioterapia mais usado na admissão foi a associação ceftriaxone com azitromicina. Em 32 doentes em que foi possível avaliar a adequação terapêutica, 27 estavam sob esquemas de antibioterapia adequados. Foram submetidos a ventilação mecânica 66 doentes (86,8%), com uma duração mediana de 4 dias. A demora mediana foi de 5,3 dias. A mortalidade na unidade foi de 36,8% e a hospitalar de 55,26%.

O índice SAPS 2, o valor de PCR, o potássio sérico e a antibioterapia inicial não adequada relacionaram-se com maior mortalidade. Após análise multivariada, apenas o índice SAPS II manteve significado estatístico.

O uso da antibioterapia deve ser criterioso, tendo em conta os principais agentes e a sua susceptibilidade.

Rev Port Pneumol 2010; XVI (2): 223-235

Palavras-chave:
Infecções adquiridas na comunidade
pneumonia
cuidados intensivos
Abstract

Community-acquired pneumonia (CAP) is the leading cause of sepsis in adult critical care.

We present a retrospective study of patients admitted to a polyvalent intensive care unit with CAP from 1st June 2004 – 31st December 2006.

We analysed 76 patients with a mean age of 62.88 (18.75) years. Mean APACHE II score was 24.88 (9.75). Mean SAPS II was 51.18 (18.05), with a predicted mortality of 47.27%. Aetiology was identified in 42.1% of the patients. Streptococcus pneumoniae was the most frequent aetiological agent, but the group of aetiological agents more frequently identified was Gram-negative enteric bacilli.

Levofloxacine was the most frequently previously used antibiotic. The most frequently used antibiotherapy scheme was the association ceftriaxone – azithromicine. It was possible to evaluate suitability of treatment in 32 patients; 27 were on suitable antibiotherapy regimes. 66 patients (86.8%) were on respirators, with a median length of 4 days. The median length of stay was 5.3days. ICU mortality was 36.8% and hospital mortality 55.26%.

SAPS II, CRP (C-reactive protein), potassium and initial unsuitable antibiotherapy were related to mortality. After multivariate analysis, only SAPS II maintained statistical significance.

Use of antibiotics should be judicious, taking the most frequent agents and their susceptibility into consideration.

Rev Port Pneumol 2010; XVI (2): 223-235

Key-words:
Community-acquired infections
pneumonia
critical care
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Copyright © 2010. Sociedade Portuguesa de Pneumologia/SPP
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