Study of community-acquired pneumonia: Incidence, patterns of care, and outcomes in primary and hospital care

Background: To asses the incidence, patterns of care, and outcomes of community-acquired pneumonia (CAP) in the population of a defined geographic area. Methods: Prospective study conducted from April 1, 2006, to June 30, 2007. All adult patients (age >= 18) with CAP in the Comarca Interior region of northern Spain were identified through the region's 150 family physicians and the emergency department (ED) of the area's general teaching hospital. Results: During a 15-month period, 960 patients with CAP were identified: 418 hospitalized and 542 ambulatory patients. The hospitalization rate was 43.5% and the global 30-day mortality was 4% (38 patients). Of the patients treated at home, most (90.4%) had mild pneumonia, only 3.1% (17 patients) were subsequently hospitalized, with a 30-day mortality rate of 0%. However, 48.9% were not treated according to antibiotic recommendations of the Spanish Society of Pneumology. Mean duration of return to daily activity was 18.8 days for the entire population. The incidence study was restricted to the first 12 months, during which 787 patients fulfilled the inclusion criteria. This represented an incidence of pneumonia of 3.1/1000 adults per year. Both the incidence of CAP and hospitalization for it rose with age. Conclusions: Our study offers information about CAP in the general population and provides feedback for the management of CAP. Although the selection of patients to be treated at home was appropriate, the choice of empiric antibiotic therapy for ambulatory CAP was problematic. (C) 2010 The British Infection Society. Published by Elsevier Ltd. All rights reserved.