PURPOSE: Community-acquired pneumonia (CAP) is the leading cause of death due to infectious diseases with important implications for health-care systems. It is unknown what is the true incidence of CAP in hospitalized patients with suspected pneumonia.
METHODS: Retrospective analysis of 113 patients admitted with the diagnosis of CAP in a teaching hospital from January 2006 to April 2006. Patients are admitted to medical floors based on hospital approved CAP pathway as Quality Improvement Project. Pneumonia is defined as two or more respiratory symptoms,signs and an opacity on a chest radiograph as interpreted by the radiologist.
RESULTS: One hundred and thirteen patients admitted with the diagnosis of CAP based on respiratory symptoms. Of these 54 patients met both clinical and radiological criteria. The other diagnosis entertained are congestive heart failure(17), chronic obstructive pulmonary disease exacerbation (5),acute bronchitis (3)and other non-respiratory medical illness (34). Of the 54 patients diagnosed with CAP, only three patients have positive blood cultures (2 patients with staphylococcus aureus and one patient with Group A streptococcus pneumonia). Length of stay was 4.6 days and no mortality during the study period.
CONCLUSION: Less than 50% of patients had CAP based on the clinical and radiological criteria. The length of stay was within the national average. Those patients who had a prolonged stay in the hospital had positive blood cultures or co-morbid conditions.
CLINICAL IMPLICATIONS: There is a high clinical suspicion of CAP when patients present to the hospital. Aggressive intervention is warranted due to the high morbidity and mortality. Over half of the patients diagnosed with presumptive pneumonia on clinical grounds have negative chest radiograph. Based on our observation, we noted that CAP might be over diagnosed in the initial evaluation. In so doing, a diagnosis of left ventricular failure, pulmonary embolism, acute bronchitis was missed in 22% of the patients. Our study demonstrates the need for appropriate diagnosis of pneumonia and it's treatment and yet prevent over usage of antibiotics. Equally important, appropriate management of confounding illness can be made.
DISCLOSURE: Sharon Ngan, None.