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. 2015 Jan-Mar;27(1):57-63.
doi: 10.5935/0103-507X.20150010. Epub 2015 Mar 1.

Management of severe community-acquired pneumonia in Brazil: a secondary analysis of an international survey

[Article in English, Portuguese]
Lígia Rabello  1 , Catarina Conceição  2 , Katia Ebecken  1 , Thiago Lisboa  3 , Fernando Augusto Bozza  1 , Márcio Soares  1 , Pedro Póvoa  2 , Jorge Ibrain Figueira Salluh  1
Affiliations

Management of severe community-acquired pneumonia in Brazil: a secondary analysis of an international survey

[Article in English, Portuguese]
Lígia Rabello et al. Rev Bras Ter Intensiva. 2015 Jan-Mar.

Abstract
in English, Portuguese

Objective: This study aimed to evaluate Brazilian physicians' perceptions regarding the diagnosis, severity assessment, treatment and risk stratification of severe community-acquired pneumonia patients and to compare those perceptions to current guidelines.

Methods: We conducted a cross-sectional international anonymous survey among a convenience sample of critical care, pulmonary, emergency and internal medicine physicians from Brazil between October and December 2008. The electronic survey evaluated physicians' attitudes towards the diagnosis, risk assessment and therapeutic interventions for patients with severe community-acquired pneumonia.

Results: A total of 253 physicians responded to the survey, with 66% from Southeast Brazil. The majority (60%) of the responding physicians had > 10 years of medical experience. The risk assessment of severe community-acquired pneumonia was very heterogeneous, with clinical evaluation as the most frequent approach. Although blood cultures were recognized as exhibiting a poor diagnostic performance, these cultures were performed by 75% of respondents. In contrast, the presence of urinary pneumococcal and Legionella antigens was evaluated by less than 1/3 of physicians. The vast majority of physicians (95%) prescribe antibiotics according to a guideline, with the combination of a 3rd/4th generation cephalosporin plus a macrolide as the most frequent choice.

Conclusion: This Brazilian survey identified an important gap between guidelines and clinical practice and recommends the institution of educational programs that implement evidence-based strategies for the management of severe community-acquired pneumonia.

Objetivo: Avaliar a percepção dos médicos brasileiros quanto ao diagnóstico, à avaliação de gravidade, ao tratamento e à estratificação de risco em pacientes com pneumonia grave adquirida na comunidade, e compará-la com as diretrizes atuais.

Métodos: Estudo transversal realizado por meio da aplicação de um questionário anônimo a uma amostra de médicos brasileiros especialistas em cuidados intensivos, medicina de emergência, medicina interna e pneumologia. Entre outubro e dezembro de 2008, foram avaliadas as atitudes dos médicos no diagnóstico, a avaliação de risco e as intervenções terapêuticas para pacientes com pneumonia grave adquirida na comunidade.

Resultados: Responderam ao questionário 253 médicos, sendo 66% da Região Sudeste do Brasil. A maioria (60%) dos médicos que responderam tinha mais de 10 anos de experiência. Verificou-se que a avaliação de risco de pneumonia grave adquirida na comunidade foi muito heterogênea, sendo a avaliação clínica a forma de avaliação de risco mais frequente. As hemoculturas foram habitualmente realizadas por 75% dos médicos, entretanto, foi reconhecido seu fraco desempenho diagnóstico. Por outro lado, a pesquisa de antígenos urinários de Pneumococo e Legionella foi solicitada por menos de um terço dos médicos. A maioria (95%) prescreveu antibióticos de acordo com as diretrizes. A combinação de uma cefalosporina de terceira ou quarta geração com um macrolídeo foi a escolha mais comum.

Conclusão: Este inquérito brasileiro demonstrou diferenças entre as diretrizes publicadas e a prática clínica. Isso leva à necessidade de se desenvolverem programas educacionais e de adoção de protocolos para implementar estratégias baseadas em evidências no manejo da pneumonia grave adquirida na comunidade.

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Conflict of interest statement

Conflicts of interest: None.

Figures

Figure 1
Figure 1
Variables used by physicians to define the severity of community-acquired pneumonia. MV - mechanical ventilation; RR - respiratory rate; CAP - community-acquired pneumonia.
Figure 2
Figure 2
Risk assessment of community-acquired pneumonia. PSI - Pneumonia Severity Index; APACHE - acute physiology and chronic health evaluation; ATS - American Thoracic Society; SAPS - simplified acute physiology score; CAP - community-acquired pneumonia.
See this image and copyright information in PMC

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