Factores pronósticos de la neumonía neumocócica grave
Resumen
Objetivo: Determinar los factores asociados con mortalidad en pacientes con neumonía neumocócica grave.
Pacientes y Métodos: Estudio retrospectivo realizado en dos centros hospitalarios durante el periodo 1996-2009, con pacientes afectos de neumonía neumocócica bacteriémica grave. En todos los pacientes se aisló Streptococcus pneumoniae en el cultivo de sangre. Analizamos parámetros clínicos y analíticos.
Resultados: Fueron incluidos 70 pacientes, los cuales fueron hospitalizados en unidades de medicina intensiva. La edad media fue 55 años (SD 16.28), el 64% fueron hombres. Los valores de los índices de gravedad fueron: APACHE II 19.8 (SD 9,75), SOFA: 7.6 (SD 3.9) y PSI: 113.43 (SD 32). Las sensibilidad antibiótica fue: penicilina el 80%, cefotaxima el 97 %, eritromicina el 81 % y el 98% a levofloxacino. La mortalidad hospitalaria fue del 25%. El análisis multivariado mostró que la resistencia a los macrólidos (Odds Ratio= 28.34 , 95% Confidence Interval= 1.61- 498.91, p = 0.02) y los índices de gravedad: APACHEII (Odds Ratio= 0.73 , 95% Confidence Interval= 0.59-0.89, p=0.002), SOFA (Odds Ratio= 0.60 , 95% Confidence Interval= 0.43-0.84, p=0.003) y PSI (Odds Ratio = 0.93, 95% Confidence Interval= 0.90-0.97, p=0.002) se correlacionaron con la mortalidad de estos enfermos.
Conclusiones: La resistencia a los macrólidos y una alta puntuación en los índices de gravedad APACHE II, SOFA y PSI son factores asociados con mayor riesgo de mortalidad en pacientes con neumonía neumocócica grave.
Streptococcus pneumoniae; neumonía; resistencia antibiótica; sensibilidad antibiótica; bacteremia;
Prognostic factors of serious pneumococcal pneumonia
Citas
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