Objectives: To determine the epidemiology of community-acquired pneumonia referred to the hospital and to characterize the diagnostic and therapeutic approach adopted by physicians.
Method: Retrospective epidemiological and descriptive clinical study based on case histories consistent with a diagnosis of community-acquired pneumonia (Fang et al. Medicine, 1990; 69:307-16) of patients referred to hospitals in Soria (Spain) over a period of one year. The patients were grouped by severity and the presence of risk factors for unusual etiology. Initial approaches were compared to those advocated by various sources.
Results: Three hundred eight cases of community-acquired pneumonia were diagnosed, and 82% of the patients were admitted. Mean age was 68 +/- 26 years (43% over 80 years of age). Men accounted for 56%. Two hundred seventeen patients (70%) were classified as seriously ill, 203 (66%) had risk factors for unusual etiology, and 166 (54%) were classified in both categories. Mortality among admitted patients was 13%. Etiological diagnoses did not correspond to the guidelines of the Spanish Society of Pneumology and Chest Surgery (SEPAR), with microbial identification achieved in 5%. Empirical treatment followed SEPAR guidelines in 45% of the cases. The Mensa guidelines were followed in 23% and the Sanford guidelines in 20%.
Conclusions: The incidence of community-acquired pneumonia in this population is 3.2 cases per 1,000 inhabitants/year. The population is mainly elderly and comorbidity is common, although mortality is low. We believe common criteria should be adopted for managing community-acquired pneumonia and that empirical treatment should be directed toward germs identified in each setting, based on appropriate etiological investigation.