Morbi-mortality of lower respiratory tract infections in Spain, 1997-2018

Egileak

  • L. Leache Unit of Innovation and Organization. Navarre Health Service. Pamplona. Spain
  • M. Gutiérrez-Valencia Unit of Innovation and Organization. Navarre Health Service. Pamplona. Spain
  • L.C. Saiz Unit of Innovation and Organization. Navarre Health Service. Pamplona. Spain
  • J. Erviti Therapeutics Initiative. Department of Anesthesiology, Pharmaceuticals and Therapeutics. University of British Co-lumbia. Vancouver. Canada

##plugins.pubIds.doi.readerDisplayName##:

https://doi.org/10.23938/ASSN.0962

Gako-hitzak:

Respiratory tract infections, pneumonia, hospitalization, mortality

Laburpena

Background. Lower respiratory tract infections (LRTIs) are one of the leading causes of infectious disease mortality worldwide. The aims of the study were to determine the incidence of hospitalizations due to LRTIs, and to analyze the clinical outcomes of the hospitalized patients.

Methods. An observational study of hospitalizations due to LRTIs (pneumonia and acute bronchitis/bronchiolitis) in Spain from 1997 to 2018 was carried out. Data were extracted from the national information system for hospital data.

Results. Overall, 3.5 % (IQR: 3.4-3.5 %) of total hospitalizations were caused by LRTIs, with a median incidence of 31.2 (IQR: 27.8-33.0) per 10,000 inhabitants/year. The median incidence was higher for pneumonia than for acute bronchitis/bronchiolitis cases (22.2; IQR: 19.1-23.5 vs. 9.0; IQR: 8.4-9.6 per 10,000 inhabitants/year; p < 0.001) and increased by 65.7 % from 1997 to 2018. A 41.2 % of the hospitalizations due to LRTIs took place amongst people over 74 years. The median length of stay was 8.9 days (IQR: 7.6-10.4) and was higher for hospitalizations due to pneumonia than for acute bronchitis/bronchiolitis (9.5 days; IQR: 8.3-10.6 vs. 5.7; IQR: 5.5-6.2; p < 0,001). In 89.1 % of total hospitalizations due to LRTIs, patients were discharged home. In-hospital mortality was 6.8 %, with 9,380 deaths (IQR: 8,192-10,157) per year. Mortality was higher for pneumonia (9.0 vs. 1.7 %; p < 0.001) and doubled from 1997 to 2018 (5,257 deaths in 1997 and 10,514 in 2018). A 75.5 % of the deaths occurred amongst people over 74 years.

Conclusions. LRTIs are associated with a high morbi-mortality in Spain. Effective measures that can contribute to­wards the prevention and treatment of LRTIs need to be adopted.

##plugins.generic.usageStats.downloads##

##plugins.generic.usageStats.noStats##

Erreferentziak

GBD 2016 Lower Respiratory Infections Collaborators. Estimates of the global, regional, and national morbidity, mortality, and aetiologies of lower respiratory infections in 195 countries, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Infect Dis 2018; 18: 1191-1210. https://doi.org/10.1016/S1473-3099(18)30310-4

GBD 2017 Causes of Death Collaborators. Global, regional, and national age-sex specific mortality for 282 causes of death in 195 countries and territories, 1980-2017: A systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018; 392: 1736-1788. https://doi.org/10.1016/S0140-6736(18)32203-7

TOLEDO D, SOLDEVILA N, TORNER N, PÉREZ-LOZANO MJ, ESPEJO E, NAVARRO G et al. Factors associated with 30-day readmission after hospitalisation for community-acquired pneumonia in older patients: a cross-sectional study in seven Spanish regions. BMJ Open 2018; 8: e020243. https://doi.org/10.1136/bmjopen-2017-020243

SANZ F, MORALES-SUÁREZ-VARELA M, FERNÁNDEZ E, FORCE L, PÉREZ-LOZANO MJ, MARTÍN V et al. A composite of functional status and pneumonia severity index improves the prediction of pneumonia mortality in older patients. J Gen Intern Med 2018; 33: 437-444. https://doi.org/10.1007/s11606-017-4267-8

DE MIGUEL-DÍEZ J, JIMÉNEZ-GARCÍA R, HERNÁNDEZ-BARRERA V, JIMÉNEZ-TRUJILLO I, DE MIGUEL-YANES JM, MÉNDEZ-BAILÓN M et al. Trends in hospitalizations for community-acquired pneumonia in Spain: 2004 to 2013. Eur J Intern Med 2017; 40: 64-71. https://doi.org/10.1016/j.ejim.2016.12.010

POLVERINO E, TORRES A, MENENDEZ R, CILLÓNIZ C, VALLES JM, CAPELASTEGUI A et al. Microbial aetiology of healthcare associated pneumonia in Spain: a prospective, multicentre, case-control study. Thorax 2013; 68: 1007-1014. https://doi.org/10.1136/thoraxjnl-2013-203828

SAIZ LC, GARJÓN J, GORRICHO J, ERVITI J, GIL-GARCÍA MJ, MARTÍN-MERINO E. Validation and incidence of community-acquired pneumonia in patients with type 2 diabetes in the BIFAP Database. Epidemiol Infect 2017; 145: 3056-3064. https://doi.org/10.1017/S0950268817001868

Subdirección General de Información Sanitaria. Ministerio de Sanidad, Consumo y Bienestar Social del Gobierno de España. Conjunto Mínimo Básico de Datos-Hospitalización (CMBD-H). Registro de Actividad de Atención Especializada (RAE-CMBD). [Accessed February 14, 2021]. https://pestadistico.inteligenciadegestion.mscbs.es/PUBLICOSNS/Comun/ArbolNodos.aspx?idNodo=23525

Subdirección General de Información Sanitaria e Innovación. Dirección General de Salud Pública, Calidad e Innovación. Ministerio de Sanidad, Consumo y Bienestar Social del Gobierno de España. eCIE9MC. Edición electrónica de la CIE-9-MC. 9ª Revisión, modificación clínica, [Accessed October 21, 2019]. https://eciemaps.mscbs.gob.es/ecieMaps/browser/index_9_mc.html; 2014

Subdirección General de Información Sanitaria e Innovación. Dirección General de Salud Pública, Calidad e Innovación. Ministerio de Sanidad, Consumo y Bienestar Social del Gobierno de España. eCIE10ES. Edición electrónica de la CIE-10-ES. 2ª edición. [Accessed October 21, 2019]. https://eciemaps.mscbs.gob.es/ecieMaps/browser/metabuscador.html; 2018

WELTE T, TORRES A, NATHWANI D. Clinical and economic burden of community-acquired pneumonia among adults in Europe. Thorax 2012; 67: 71-79. https://doi.org/10.1136/thx.2009.129502

TORRES A, PEETERMANS WE, VIEGI G, BLASI F. Risk factors for community-acquired pneumonia in adults in Europe: a literature review. Thorax 2013; 68: 1057-1065. https://doi.org/10.1136/thoraxjnl-2013-204282

The Institute for Health Metrics and Evaluation. University of Washington (USA). Global Burden Disease (GBD) Compare - Viz Hub. [Accessed February 19, 2021]. https://vizhub.healthdata.org/gbd-compare/

LI G, COOK DJ, THABANE L, FRIEDRICH JO, CROZIER TM, MUSCEDERE J et al. Risk factors for mortality in patients admitted to intensive care units with pneumonia. Respir Res 2016; 17: 80. https://doi: 10.1186/s12931-016-0397-5

YOKOE DS, ANDERSON DJ, BERENHOLTZ SM, CALFEE DP, DUBBERKE ER, ELLINGSON KD et al. A compendium of strategies to prevent healthcare-associated infections in acute care hospitals: 2014 updates. Infect Control Hosp Epidemiol 2014; 35: 967-977. https://doi.org/10.1086/677216

TABLAN OC, ANDERSON LJ, BESSER R, BRIDGES C, HAJJEH R; CDC; Healthcare Infection Control Practices Advisory Committee. Guidelines for preventing health-care-associated pneumonia, 2003: recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee. MMWR Recomm Rep 2004; 53: 1-36

KALIL AC, METERSKY ML, KLOMPAS M, MUSCEDERE J, SWEENEY DA, PALMER LB et al. Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 clinical practice guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis 2016; 63: e61-e111. https://doi.org/10.1093/cid/ciw353

TORRES A, NIEDERMAN MS, CHASTRE J, EWIG S, FERNANDEZ-VANDELLOS P,HANBERGER H et al. International ERS/ESICM/ESCMID/ALAT guidelines for the management of hospital-acquired pneumonia and ventilator-associated pneumonia: Guidelines for the management of hospital-acquired pneumonia (HAP)/ventilator-associated pneumonia (VAP) of the European Respiratory Society (ERS), European Society of Intensive Care Medicine (ESICM), European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and Asociación Latinoamericana del Tórax (ALAT). Eur Respir J 2017; 50: 1700582. https://doi.org/10.1183/13993003.00582-2017

SINUFF T, MUSCEDERE J, COOK DJ, DODEK PM, ANDERSON W, KEENAN SP et al. Implementation of clinical practice guidelines for ventilator-associated pneumonia: a multicenter prospective study. Crit Care Med 2013; 41: 15-23. https://doi.org/10.1097/CCM.0b013e318265e874

BERENHOLTZ SM, PHAM JC, THOMPSON DA, NEEDHAM DM, LUBOMSKI LH, HYZY RC et al. Collaborative cohort study of an intervention to reduce ventilator-associated pneumonia in the intensive care unit. Infect Control Hosp Epidemiol 2011; 32: 305-314. https://doi.org/10.1086/658938

EOM JS, LEE MS, CHUN HK, CHOI HJ, JUNG SY, KIM YS et al. The impact of a ventilator bundle on preventing ventilator-associated pneumonia: a multicenter study. Am J Infect Control 2014; 42: 34-37. https://doi.org/10.1016/j.ajic.2013.06.023

ÁLVAREZ LERMA F, SÁNCHEZ GARCÍA M, LORENTE L, GORDO F, AÑÓN JM, ÁLVAREZ J et al. Guidelines for the prevention of ventilator-associated pneumonia and their implementation. The Spanish "Zero-VAP" bundle. Med Intensiva 2014; 38: 226-236. https://doi.org/10.1016/j.medin.2013.12.007

ÁLVAREZ-LERMA F, PALOMAR-MARTÍNEZ M, SÁNCHEZ-GARCÍA M, MARTÍNEZ-ALONSO M, ÁLVAREZ-RODRÍGUEZ J, LORENTE L et al. Prevention of ventilator-associated pneumonia: the multimodal approach of the Spanish ICU "Pneumonia Zero" program. Crit Care Med 2018; 46: 181-188. https://doi.org/10.1097/CCM.0000000000002736

##submission.downloads##

Argitaratuta

2021-12-27

Zenbakia

Atala

Artículos originales