Protocolo clínico de diagnóstico y tratamiento de pacientes con neumonía adquirida en la comunidad que ingresan a la Unidad de Cuidados Intensivos.

  • Fausto Marcos Guerrero Toapanta Hospital de Especialidades Carlos Andrade Marín
  • Yeimi Del Carmen Herrera Parra Hospital de Especialidades Carlos Andrade Marín
Palabras clave: Neumonía, Neumonía Bacteriana, Neumonía Estafilocócica, Neumonía Neumocócica, Neumonía por Mycoplasma, Neumonía por Clamidia

Resumen

1. INTRODUCCIÓN
La neumonía es una infección frecuente que se presenta en todas las edades, en cualquier tipo de pacientes y a nivel comunitario u hospitalario. La neumonía que se origina en la comunidad afecta a los pacientes con comorbilidades y en los extremos de la vida. La mortalidad de la neumonía comunitaria (NC) permanece elevada, los sistemas de salud deben implementar estrategias para diagnosticar y tratar de forma rápida a
estos pacientes. Cuando un paciente con neumonía comunitaria es ingresado en la emergencia de cualquier hospital se debe categorizar su estado para que reciba el mejor tratamiento posible. La Unidad de Cuidados Intensivos (UCI) participa en la detección de los pacientes con neumonía adquirida en la comunidad grave,
con el objetivo de priorizar su atención para lograr las metas de manejo lo más rápido posible y disminuir la mortalidad de estos pacientes.

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Magiorakos A-P, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect [Internet]. Marzo de 2012 [citado 9 de octubre de 2019]; 18(3):268-81. DOI: 10.1111/j.1469-0691.2011.03570.x Available from: https://pubmed.ncbi.nlm.nih.gov/21793988/

Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, et al. American Thoracic Society Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007; 44(Suppl 2):S27–S72. Available from: https://www.thoracic.org/statements/resources/mtpi/idsaats-cap.pdf

Garcia-Vidal C, Almagro P, Romani V, Rodriguez-Carballeira M, Cuchi E, Canales L, et al. Pseudomonas aeruginosa in patients hospitalised for COPD exacerbation: a prospective study. Eur Respir J. 2009; 34(5):1072–1078. DOI: 10.1183/09031936.00003309. Available from: https://erj.ersjournals.com/content/34/5/1072

Wunderink RG, Waterer G. Advances in the causes and management of community acquired pneumonia in adults. Bmj. 2017; 358:j2471. DOI: 10.1136/bmj.j2471. Available from: https://pubmed.ncbi.nlm.nih.gov/28694251/

Jiménez A, Alvarado A, Gómez F, Carrero G, Fajardo C. Factores de riesgo asociados al aislamiento de Escherichia coli o Klebsiella pneumoniae productoras de betalactamasas de espectro extendido en un hospital de cuarto nivel en Colombia. Biomédica. 2014; 34(1):16–22. DOI: https://doi.org/10.7705/biomedica.v34i0.1650. Disponible en: https://revistabiomedica.org/index.php/biomedica/article/view/1650

Mendelson G, Hait V, Ben-Israel J, Gronich D, Granot E, Raz R. Prevalence and risk factors of extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae in an Israeli long-term care facility. Eur J Clin Microbiol Infect Dis. 2005; 24(1):17–22. DOI: 10.1007/s10096-004-1264-8. Available from: https://link.springer.com/article/10.1007/s10096-004-1264-8

Cillóniz C, Dominedò C, Nicolini A, Torres A. PES Pathogens in Severe Community-Acquired Pneumonia. Microorganisms [Internet]. 12 de febrero de 2019 [citado 10 de octubre de 2019]; 7(2):49. Available from: http://www.mdpi.com/2076-2607/7/2/49

Torres A, Chalmers JD, Dela Cruz CS, Dominedò C, Kollef M, Martin-Loeches I, et al. Challenges in severe community-acquired pneumonia: a point-of-view review. Intensive Care Med [Internet]. Febrero de 2019 [citado 9 de octubre de 2019]; 45(2):159-71. Available from: http://link.springer.com/10.1007/s00134-019-05519-y

Cillóniz C, Dominedò C, Torres A. Multidrug Resistant Gram-Negative Bacteria in Community-Acquired Pneumonia. Crit Care [Internet]. Diciembre de 2019 [citado 10 de octubre de 2019]; 23(1). Available from: https://ccforum.biomedcentral.com/articles/10.1186/s13054-019-2371-3

De Bus L, Depuydt P, Steen J, Dhaese S, De Smet K, Tabah A, et al. Antimicrobial de-escalation in the critically ill patient and assessment of clinical cure: the DIANA study. Intensive Care Med. 2020; 46(7):1404-1417. DOI: 10.1007/s00134-020-06111-5. Available from: http://10.0.3.239/s00134-020-06111-5. Available from. https://pubmed.ncbi.nlm.nih.gov/32519003/

Bartlett JG, Dowell SF, Mandell LA, File Jr TM, Musher DM, Fine MJ. Practice guidelines for the management of community-acquired pneumonia in adults. Clin Infect Dis. 2000; 31(2):347–382. DOI: 10.1086/313954. Available from: https://academic.oup.com/cid/article/31/2/347/293404

Prina E, Ranzani OT, Torres A. Community-acquired pneumonia. The Lancet. 2015; 386(9998):1097–1108. DOI: 10.1016/S0140-6736(15)60733-4. Available from: https://pubmed.ncbi.nlm.nih.gov/26277247/

Fernández-Serrano S, Dorca J, Garcia-Vidal C, Fernández-Sabé N, Carratalà J, Fernández-Agüera A, et al. Effect of corticosteroids on the clinical course of community-acquired pneumonia: a randomized controlled trial. Crit Care [Internet]. 2011 [citado 8 de octubre de 2019]; 15(2):R96. Available from: http://ccforum.biomedcentral.com/articles/10.1186/cc10103

Lim WS, Baudouin SV, George RC, Hill AT, Jamieson C, Le Jeune I, et al. BTS guidelines for the management of community acquired pneumonia in adults: update 2009. Thorax. 2009; 64(Suppl 3):iii1–iii55. DOI: http://dx.doi.org/10.1136/thx.2009.121434. Available from: https://thorax.bmj.com/content/64/Suppl_3/iii1

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(11):1007–1014. DOI: 10.1136/thoraxjnl-2013-203828. Available from: https://thorax.bmj.com/content/68/11/1007

Postma DF, Van Werkhoven CH, Van Elden LJ, Thijsen SF, Hoepelman AI, Kluytmans JA, et al. Antibiotic treatment strategies for community-acquired pneumonia in adults. N Engl J Med. 2015; 372(14):1312–1323. DOI: 10.1056/NEJMoa1406330. Available from: https://www.nejm.org/doi/full/10.1056/nejmoa1406330

Viasus D, Núñez-Ramos JA, Viloria SA, Carratalà J. Pharmacotherapy for community-acquired pneumonia in the elderly. Expert Opin Pharmacother. 2017;(just-accepted). DOI: 10.1080/14656566.2017.1340940. Available from: https://www.tandfonline.com/doi/abs/10.1080/14656566.2017.1340940?journalCode=ieop20

Niederman MS, Mandell LA, Anzueto A, Bass JB, Broughton WA, Campbell GD, et al. Guidelines for the management of adults with community-acquired pneumonia: diagnosis, assessment of severity, antimicrobial therapy, and prevention. Am J Respir Crit Care Med. 2001; 163(7):1730–1754. DOI: 10.1164/ajrccm.163.7.at1010. Available from: https://pubmed.ncbi.nlm.nih.gov/11401897/

Metlay JP, Waterer GW, Long AC, Anzueto A, Brozek J, Crothers K, et al. Diagnosis and Treatment of Adults with Community-acquired Pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med [Internet]. 1 de octubre de 2019 [citado 22 de enero de 2020]; 200(7):e45-67. Disponible en: https://www.atsjournals.org/doi/10.1164/rccm.201908-1581ST

Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, Fan E, Camporota L, et al. Acute Respiratory Distress Syndrome: The Berlin Definition. JAMA [Internet]. 20 de junio de 2012 [citado 30 de diciembre de 2020]; 307(23). Available from: https://pubmed.ncbi.nlm.nih.gov/22797452/

Tracy MC, Mathew R. Complicated pneumonia: current concepts and state of the art. Curr Opin Pediatr [Internet]. Junio de 2018 [citado 30 de diciembre de 2020]; 30(3):384-92. DOI: 10.1097/MOP.0000000000000619. Available from: http://journals.lww.com/00008480-201806000-00013

Ferreiro L, Suárez-Antelo J, Toubes ME, Valdés L. Toracocentesis en Atención Primaria. Med Fam SEMERGEN [Internet]. Octubre de 2019 [citado 30 de diciembre de 2020]; 45(7):474-8. DOI: https://doi.org/10.1016/j.semerg.2019.02.005 Disponible en: https://linkinghub.elsevier.com/retrieve/pii/S1138359319300504

Figuera AP, Barreto DB, Mirambeaux R. Protocolo diagnóstico y terapéutico del derrame pleural. Med - Programa Form Médica Contin Acreditado [Internet]. Octubre de 2019 [citado 30 de diciembre de 2020]; 12(88):5193-6. DOI: https://doi.org/10.1016/j.med.2019.10.017. Disponible en: https://linkinghub.elsevier.com/retrieve/pii/S0304541219302616

Papazian L, Aubron C, Brochard L, Chiche J-D, Combes A, Dreyfuss D, et al. Formal guidelines: management of acute respiratory distress syndrome. Ann Intensive Care [Internet]. Diciembre de 2019 [citado 9 de octubre de 2019]; 9(1). Available from: https://annalsofintensivecare.springeropen.com/articles/10.1186/s13613-019-0540-9

Levy MM, Evans LE, Rhodes A. The Surviving Sepsis Campaign Bundle: 2018 update. Intensive Care Med [Internet]. Junio de 2018 [citado 9 de octubre de 2019]; 44(6):925-8. Available from: http://link.springer.com/10.1007/s00134-018-5085-0

Karakioulaki M, Stolz D. Biomarkers and clinical scoring systems in community-acquired pneumonia. Ann Thorac Med [Internet]. 2019 [citado 9 de octubre de 2019]; 14(3):165-172. Available from: http://www.thoracicmedicine.org/text.asp?2019/14/3/165/261452

Brar NK, Niederman MS. Management of community-acquired pneumonia: a review and update. Ther Adv Respir Dis. 2011; 5(1):61–78. DOI: https://doi.org/10.1177/1753465810381518. Available from: https://journals.sagepub.com/doi/10.1177/1753465810381518

Viasus D, Calatayud L, McBrown MV, Ardanuy C, Carratalà J. Urinary antigen testing in community-acquired pneumonia in adults: an update. Expert Rev Anti Infect Ther [Internet]. Febrero de 2019 [citado 10 de octubre de 2019]; 17(2):107-15. Available from: https://www.tandfonline.com/doi/full/10.1080/14787210.2019.1565994

Musher DM, Thorner AR. Community-acquired pneumonia. N Engl J Med. 2014; 371(17):1619–1628. DOI: 10.1056/NEJMra1312885. Available from: https://www.nejm.org/doi/full/10.1056/NEJMra1312885

Poritz MA, Blaschke AJ, Byington CL, Meyers L, Nilsson K, Jones DE, et al. FilmArray, an automated nested multiplex PCR system for multi-pathogen detection: development and application to respiratory tract infection. PloS One. 2011; 6(10):e26047. DOI: 10.1371/journal.pone.0026047. Available from: https://journals.plos.org/plosone/article/figure?id=10.1371/journal.pone.0026047.g003

Athlin S, Lidman C, Lundqvist A, Naucler P, Nilsson AC, Spindler C, et al. Management of community-acquired pneumonia in immunocompetent adults: updated Swedish guidelines 2017. Infect Dis [Internet]. 3 de abril de 2018 [citado 30 de diciembre de 2020]; 50(4):247-72. Available from: https://www.tandfonline.com/doi/full/10.1080/23744235.2017.1399316

Lee JS, Giesler DL, Gellad WF, Fine MJ. Antibiotic Therapy for Adults Hospitalized With Community-Acquired Pneumonia: A Systematic Review. JAMA [Internet]. 9 de febrero de 2016 [citado 9 de octubre de 2019]; 315(6):593. Available from: http://jama.jamanetwork.com/article.aspx?doi=10.1001/jama.2016.0115

Cazzola M, Rogliani P, Aliberti S, Blasi F, Matera MG. An update on the pharmacotherapeutic management of lower respiratory tract infections. Expert Opin Pharmacother. Julio de 2017; 18(10):973-88. DOI: 10.1080/14656566.2017.1328497. Available from: https://www.tandfonline.com/doi/abs/10.1080/14656566.2017.1328497

Ceccato A, Cilloniz C, Martin-Loeches I, Ranzani OT, Gabarrus A, Bueno L, et al. Effect of Combined β-Lactam/Macrolide Therapy on Mortality According to the Microbial Etiology and Inflammatory Status of Patients With Community-Acquired Pneumonia. Chest [Internet]. Abril de 2019 [citado 10 de octubre de 2019]; 155(4):795-804. Available from: https://pubmed.ncbi.nlm.nih.gov/30471269/

Prina E, Ranzani OT, Polverino E, Cillóniz C, Ferrer M, Fernandez L, et al. Risk Factors Associated with Potentially Antibiotic-Resistant Pathogens in Community-Acquired Pneumonia. Ann Am Thorac Soc [Internet]. Febrero de 2015 [citado 10 de octubre de 2019]; 12(2):153-60. DOI: https://doi.org/10.1513/AnnalsATS.201407-305OC. Available from: http://www.atsjournals.org/doi/10.1513/AnnalsATS.201407-305OC

Bantar C, Curcio D, Jasovich A, Bagnulo H, Arango Á, Bavestrello L, et al. Neumonía aguda adquirida en la comunidad en adultos: Actualización de los lineamientos para el tratamiento antimicrobiano inicial basado en la evidencia local del Grupo de Trabajo de Sudamérica (ConsenSur II). Rev Chil Infectol. 2010; 27:9–38. DOI: http://dx.doi.org/10.4067/S0716-10182010000400002. Disponible en: https://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0716-10182010000400002&lng=en&nrm=iso&tlng=en

Luyt C-E, Bréchot N, Trouillet J-L, Chastre J. Antibiotic stewardship in the intensive care unit. Crit Care. 2014; 18(5):480. DOI: 10.1186/s13054-014-0480-6. Available from: https://ccforum.biomedcentral.com/articles/10.1186/s13054-014-0480-6

Schuetz P, Christ-Crain M, Thomann R, Falconnier C, Wolbers M, Widmer I, et al. Effect of procalcitonin-based guidelines vs standard guidelines on antibiotic use in lower respiratory tract infections: the ProHOSP randomized controlled trial. Jama. 2009; 302(10):1059–1066. DOI: 10.1001/jama.2009.1297. Avialable from: https://jamanetwork.com/journals/jama/fullarticle/184544

Uranga A, España PP, Bilbao A, Quintana JM, Arriaga I, Intxausti M, et al. Duration of Antibiotic Treatment in Community-Acquired Pneumonia: A Multicenter Randomized Clinical Trial. JAMA Intern Med [Internet]. 1 de septiembre de 2016 [citado 9 de octubre de 2019]; 176(9):1257. Avialable from: http://archinte.jamanetwork.com/article.aspx?doi=10.1001/jamainternmed.2016.3633

Garnacho-Montero J, Arenzana-Seisdedos A, De Waele J, Kollef MH. To which extent can we decrease antibiotic duration in critically ill patients? Expert Rev Clin Pharmacol. 2017; 10(11):1215–1223. DOI: 10.1080/17512433.2017.1369879. Avialable from: https://www.tandfonline.com/doi/abs/10.1080/17512433.2017.1369879?journalCode=ierj20

Tansarli GS, Mylonakis E. Systematic Review and Meta-analysis of the Efficacy of Short-Course Antibiotic Treatments for Community-Acquired Pneumonia in Adults. Antimicrob Agents Chemother [Internet]. 9 de julio de 2018 [citado 9 de octubre de 2019]; 62(9). Available from: http://aac.asm.org/lookup/doi/10.1128/AAC.00635-18

Maschmeyer G, Helweg-Larsen J, Pagano L, Robin C, Cordonnier C, Schellongowski P. ECIL guidelines for treatment of Pneumocystis jirovecii pneumonia in non-HIV-infected haematology patients. J Antimicrob Chemother [Internet]. 1 de septiembre de 2016 [citado 10 de febrero de 2020]; 71(9):2405-13. Available from: https://academic.oup.com/jac/article/71/9/2405/2237835

Zhang Y, Sun W, Svendsen ER, Tang S, MacIntyre RC, Yang P, et al. Do corticosteroids reduce the mortality of influenza A (H1N1) infection? A meta-analysis. Crit Care. 2015; 19(1):46. DOI: 10.1186/s13054-015-0764-5. Available from: https://pubmed.ncbi.nlm.nih.gov/25888424/

Lee N, Leo Y-S, Cao B, Chan PK, Kyaw WM, Uyeki TM, et al. Neuraminidase inhibitors, superinfection and corticosteroids affect survival of influenza patients. Eur Respir J. 2015; ERJ–01697. DOI: 10.1183/09031936.00169714. Avialable from: https://erj.ersjournals.com/content/45/6/1642

Torres A, Sibila O, Ferrer M, Polverino E, Menendez R, Mensa J, et al. Effect of Corticosteroids on Treatment Failure Among Hospitalized Patients With Severe Community-Acquired Pneumonia and High Inflammatory Response: A Randomized Clinical Trial. JAMA [Internet]. 17 de febrero de 2015 [citado 9 de octubre de 2019]; 313(7):677. Available from: http://jama.jamanetwork.com/article.aspx?doi=10.1001/jama.2015.88

Blum CA, Nigro N, Briel M, Schuetz P, Ullmer E, Suter-Widmer I, et al. Adjunct prednisone therapy for patients with community-acquired pneumonia: a multicentre, double-blind, randomised, placebo-controlled trial. The Lancet [Internet]. Abril de 2015 [citado 9 de octubre de 2019]; 385(9977):1511-8. DOI: DOI:https://doi.org/10.1016/S0140-6736(14)62447-8. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0140673614624478

Pliakos EE, Andreatos N, Tansarli GS, Ziakas PD, Mylonakis E. The Cost-Effectiveness of Corticosteroids for the Treatment of Community-Acquired Pneumonia. Chest [Internet]. Abril de 2019 [citado 9 de octubre de 2019]; 155(4):787-94. DOI: https://doi.org/10.1016/j.chest.2018.11.001. Disponible en: https://linkinghub.elsevier.com/retrieve/pii/S0012369218327272

Chen L, Han X, Li Y, Zhang C, Xing X. [Impact of systemic corticosteroids on the clinical outcomes in patients with severe community-acquired pneumonia: a multi-center retrospective study]. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. Julio de 2019; 31(7):815-20. DOI: 10.3760/cma.j.issn.2095-4352.2019.07.004. Available from: https://www.google.com/search?client=firefox-b-d&q=DOI%3A+10.3760%2Fcma.j.issn.2095-4352.2019.07.004

Jiang S, Liu T, Hu Y, Li R, Di X, Jin X, et al. Efficacy and safety of glucocorticoids in the treatment of severe community-acquired pneumonia: A meta-analysis. Medicine (Baltimore) [Internet]. Junio de 2019 [citado 10 de octubre de 2019]; 98(26):e16239. DOI: 10.1097/MD.0000000000016239. Available from: https://pubmed.ncbi.nlm.nih.gov/31261585/

Huang J, Guo J, Li H, Huang W, Zhang T. Efficacy and safety of adjunctive corticosteroids therapy for patients with severe community-acquired pneumonia: A systematic review and meta-analysis. Medicine (Baltimore) [Internet]. Marzo de 2019 [citado 10 de octubre de 2019]; 98(13):e14636. DOI: 10.1097/MD.0000000000014636. Available from: https://pubmed.ncbi.nlm.nih.gov/30921179/

Wang L, Liang H, Ye L, Jiang J, Liang B, Huang J. Adjunctive corticosteroids for the treatment of Pneumocystis jiroveci pneumonia in patients with HIV: A meta-analysis. Exp Ther Med [Internet]. Febrero de 2016 [citado 10 de febrero de 2020]; 11(2):683-7. Available from: https://www.spandidos-publications.com/10.3892/etm.2015.2929

Pereira JM, Laszczyńska O, Azevedo A, Basílio C, Sousa-Dias C, Mergulhão P, et al. Early prediction of treatment failure in severe community-acquired pneumonia: The PRoFeSs score. J Crit Care [Internet]. Octubre de 2019 [citado 9 de octubre de 2019]; 53:38-45. DOI: https://doi.org/10.1016/j.jcrc.2019.05.020 Available from: https://linkinghub.elsevier.com/retrieve/pii/S088394411831832X

Espinoza R, Silva JRL e, Bergmann A, de Oliveira Melo U, Calil FE, Santos RC, et al. Factors associated with mortality in severe community-acquired pneumonia: A multicenter cohort study. J Crit Care [Internet]. Abril de 2019 [citado 10 de octubre de 2019]; 50:82-6. DOI: https://doi.org/10.1016/j.jcrc.2018.11.024. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0883944118309900

Yin Y-D, Wang R, Zhuo C, Wang H, Wang M-G, Xie C-M, et al. Macrolide-resistant Mycoplasma pneumoniae prevalence and clinical aspects in adult patients with community-acquired pneumonia in China: a prospective multicenter surveillance study. J Thorac Dis [Internet]. Octubre de 2017 [citado 9 de octubre de 2019]; 9(10):3774-81. Available from: http://jtd.amegroups.com/article/view/16269/13411

Wunderink R, Yin Y. Antibiotic Resistance in Community-Acquired Pneumonia Pathogens. Semin Respir Crit Care Med [Internet]. 13 de diciembre de 2016 [citado 9 de octubre de 2019]; 37(06):829-38. Available from: http://www.thieme-connect.de/DOI/DOI?10.1055/s-0036-1593753

Carmona EM, Limper AH. Update on the diagnosis and treatment of Pneumocystis pneumonia. Ther Adv Respir Dis. 2011; 5(1):41–59. DOI: 10.1177/1753465810380102. Available from: https://journals.sagepub.com/doi/10.1177/1753465810380102

Salzer HJF, Burchard G, Cornely OA, Lange C, Rolling T, Schmiedel S, et al. Diagnosis and Management of Systemic Endemic Mycoses Causing Pulmonary Disease. Respiration [Internet]. 2018 [citado 9 de octubre de 2019]; 96(3):283-301. Available from: https://www.karger.com/Article/FullText/489501

Publicado
2021-09-29
Cómo citar
Guerrero Toapanta, F., & Herrera Parra, Y. (2021). Protocolo clínico de diagnóstico y tratamiento de pacientes con neumonía adquirida en la comunidad que ingresan a la Unidad de Cuidados Intensivos. Revista Médica-Científica CAMbios HECAM, 20(1), 107-116. https://doi.org/10.36015/cambios.v20.n1.2021.636