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J Crit Care. 2014 Oct;29(5):743-7. doi: 10.1016/j.jcrc.2014.05.019. Epub 2014 May 29.

Management of severe community-acquired pneumonia: a survey on the attitudes of 468 physicians in Iberia and South America.

Author information

1
D'or Institute for Research and Education, Rio de Janeiro, Brazil; Postgraduation Program, Instituto Nacional de Câncer, Rio de Janeiro, Brazil. Electronic address: jorgesalluh@yahoo.com.br.
2
Intensive Care Unit and Infection Control Committee, Hospital das Clínicas, Postgraduation Program Pneumology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Rede Institucional de Pesquisa e Inovação em Medicina Intensiva (RIPIMI)-Complexo Hospitalar Santa Casa, Porto Alegre, Brazil.
3
D'or Institute for Research and Education, Rio de Janeiro, Brazil; Instituto de Pesquisa Clínica Evandro Chagas, FIOCRUZ, Rio de Janeiro, Brazil.
4
D'or Institute for Research and Education, Rio de Janeiro, Brazil; Postgraduation Program, Instituto Nacional de Câncer, Rio de Janeiro, Brazil.
5
Polyvalent Intensive Care Unit, Hospital de São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental, CEDOC, Faculty of Medical Sciences, New University of Lisbon, Lisboa, Portugal.

Abstract

PURPOSE:

The purpose of this study is to characterize the practices of pulmonary, internal medicine, and critical care physicians toward the management of patients with severe community-acquired pneumonia (CAP).

MATERIALS AND METHODS:

A cross-sectional international anonymous survey was conducted among a convenience sample of critical care, pulmonary, emergency, and internal medicine physicians from Portugal, Spain, and South America between October and December 2008. The electronic survey evaluated physicians' attitudes toward diagnosis, risk assessment, and therapeutic interventions for patients with severe CAP.

RESULTS:

Four hundred sixty-eight physicians responded being 84.6% from 4 countries (Brazil, Portugal, Spain, and Argentina) whom 66.9% had more than 10 years experience. Risk assessment of severe CAP was very heterogeneous being clinical evaluation the most frequent. Although blood cultures were recognized as presenting a poor diagnostic performance, they were performed by 77.1%. In opposition, the presence of urinary pneumococcal and Legionella antigen was asked by less than one-third of physicians. The great majority (95%) prescribes antibiotics according to a guideline being the combination of β-lactam plus macrolide the most frequent choice.

CONCLUSIONS:

Despite the recent advances of knowledge reflected in the present study in the management of severe CAP, several of them are still incompletely translated into clinical practice. Significant variation in practice is observed among physicians and represents a potential target for future research and educational interventions.

KEYWORDS:

Antimicrobials; Mechanical ventilation; Multiple organ failure; Sepsis; Severe community-acquired pneumonia

PMID:
24973102
DOI:
10.1016/j.jcrc.2014.05.019
[Indexed for MEDLINE]
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