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Vol. 46. Issue S7.
Neumología de urgencias
Pages 26-30 (October 2010)
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Vol. 46. Issue S7.
Neumología de urgencias
Pages 26-30 (October 2010)
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Neumonía adquirida en la comunidad
Community-acquired pneumonia
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60308
José Blanquera,
Corresponding author
blanquer_jos@gva.es

Autor para correspondencia.
, Francisco Sanzb
a Unidad Cuidados Intensivos Respiratorios, Hospital Clínic Universitari, Valencia, España
b Servicio de Neumología, Consorci Hospital General Universitari, Valencia, España
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Resumen

La estratificación del riesgo de la neumonía adquirida en la comunidad (NAC) a su llegada a urgencias médicas es la clave principal para diferenciar los pacientes con NAC en tres subgrupos según el lugar donde se debe efectuar el tratamiento inicial: extrahospitalario, ingreso en salas de hospitalización, requerimiento de ingreso en la unidad de cuidados intensivos (UCI), dadas las dificultades inherentes a conocer la etiología causal de la NAC (el diagnóstico etiológico se alcanza sólo en 40–60% de los casos). Las dos escalas de riesgo más usadas son: el Pneumonia Severity Index (PSI) o escala de Fine y el CURB-65, útiles sobre todo para evaluar la necesidad de ingreso hospitalario. Los criterios de la normativa ATS-IDSA de 2007 son los más utilizados para valorar el ingreso del paciente con NAC en la UCI. Las posibles diferencias etiológicas y evolutivas de los tres grupos de pacientes ya citados son la base de la diversidad de pruebas diagnósticas y de tratamiento empírico que requerirán cada uno de ellos, aunque en los tres subgrupos se ha de contemplar la posible etiología neumocócica, dado que Streptococcus pneumoniae es el agente causal más frecuente de la NAC en cada uno de ellos. Se considera esencial una nueva evaluación del estado clínico del paciente a las 48 h de haber iniciado el tratamiento empírico.

Palabras clave:
Neumonía adquirida en la comunidad
Escala de Fine
CURB-65
Escala de ATS-IDSA para ingreso en unidad
de cuidados intensivos
Tratamiento empírico
Abstract

Given the inherent difficulty of determining the cause of community-acquired pneumonia (CAP) (an etiological diagnosis is only established in 40–60 % of cases), assessment of severity plays a key role in stratifying CAP patients arriving at the emergency department in three groups according to the need for hospitalization: outpatient, hospitalization, and the need for intensive care unit (ICU) admission. The two most common severity scales used to assess the need for hospital admission in CAP are the Pneumonia Severity Index (PSI) and CURB-65 score while ATS-IDSA 2007 criteria are specific to evaluate the need for ICU admission. Because of the possible etiological differences between the three groups, distinct etiological tests and empiric antibiotic treatments will be required in each subgroup, although a possible pneumococcal etiology should always be considered, since Streptococcus pneumoniae is the most common etiology of CAP in all three groups. Clinical status must be reassessed 48 hours after empirical antibiotic treatment is started.

Keywords:
Community-acquired pneumonia
Fine's score
CURB-65
ATS-IDSA criteria for UCI admission
Empirical treatment
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Copyright © 2010. Sociedad Española de Neumología y Cirugía Torácica
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