Epidemiología y manejo de la neumonía adquirida en la comunidad durante más de una década

espanolObjetivo Describir las caracteristicas de los pacientes diagnosticados de neumonia adquirida en la comunidad (NAC) en nuestra zona basica de salud, su manejo, evolucion y utilizacion de escalas pronosticas impulsados por los escasos estudios realizados desde Atencion Primaria (AP) sobre estos aspectos. Material y metodos Estudio observacional descriptivo transversal sobre la poblacion de 3 centros de salud urbanos, diagnosticada de NAC en el periodo del 1/1/2000 al 31/7/2013, obteniendose una muestra de 1.290 pacientes. Resultados El 56,1% eran hombres y la edad media de la poblacion era de 61,9 anos. El 22,7% eran fumadores. El 59,9% presentaba patologia existente en las escalas pronosticas, estando presente la diabetes mellitus en un 20%. El 36,1% tenia patologia pulmonar (17,6% EPOC, 11,8% asma). En AP se diagnosticaron el 43,2% del total. La radiografia diagnostica estaba presente en el 92,7% de los casos y la de control en el 59,4%. Se registraron escalas pronosticas en el 2% de los casos. Los antibioticos mas utilizados fueron amoxicilina-clavulanico (30,7%) y levofloxacino (30,4%). Tener patologia previa incrementa en 1,6 el riesgo de retratamiento [ICred 95% (1,1-2,2)]. El riesgo de mortalidad se multiplica por 5,3 en caso de presentar patologia previa [ICred 95% (1,3-19,2]. Conclusiones En nuestro medio la NAC es una enfermedad frecuente y potencialmente grave, la cual la presentan —en la mitad de los casos— pacientes con comorbilidad asociada. Si hablamos de tratamiento y manejo, cabe destacar el amplio uso que hacemos de amoxicilina-clavulanico frente a un uso escaso de amoxicilina, terapia combinada y escalas pronosticas EnglishObjective To describe the characteristics of patients diagnosed with Community Acquired Pneumonia in this basic health area, their management, outcomes, and use of prognostic scales driven by the few studies carried out from Primary Care on these aspects. Material and methods Descriptive cross-sectional study on a population diagnosed with Community Acquired Pneumonia if three urban health centres, during the period January 2000 to 31 July 2103. Results Out of a sample of 1,290 patients obtained, 56.1% were men, and the mean age of the population was 61.9 years. There were 22.7% smokers. More than half (59.9%) had a disease in the prognostic scales, with Diabetes Mellitus present in 20%, and 36.1% with pulmonary disease (17.6% COPD, 11.8% asthma). Just under half (43.2%) of the total patients were diagnosed in Primary Care. There was a diagnostic X-ray in 92.7% of the cases, and a follow-up X-ray in 59.4%. Prognostic scales were recorded in 2% of the cases. The most commonly used antibiotics were amoxicillin-clavulanic (30.7%) and levofloxacin (30.4%). Having prior disease increases the risk of re-treatment by 1.6 (95% CI; 1.1-2.2)]. The mortality risk is multiplied by 5.3 on having a previous disease (95% CI; 1.3-19.2). Conclusions In the Primary Care setting, Community Acquired Pneumonia is a common and potentially serious disease which, in half the cases, occurs in patients with associated comorbidity. As regards treatment and management, is highlighted the wide use made of amoxicillin-clavulanic, compared to the low use of amoxicillin, combined therapy, and prognostic scales.