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Open Access Highly Accessed Research article

Retrospective epidemiological study for the characterization of community- acquired pneumonia and pneumococcal pneumonia in adults in a well-defined area of Badalona (Barcelona, Spain)

Antoni Sicras-Mainar1*, Jordi Ibáñez-Nolla2, Isabel Cifuentes3, Pablo Guijarro4, Ruth Navarro-Artieda5 and Lorenzo Aguilar6

Author affiliations

1 Planning Management Department, Dirección de Planificación y Desarrollo Organizativo, Badalona Serveis Assistencials SA, Gaietà Soler, 6-8 entlo, 08911, Badalona, Barcelona, Spain

2 Hospital Municipal de Badalona, Badalona, Barcelona, Spain

3 Medical Department, Pfizer S.L.U., Alcobendas, Madrid, Spain

4 Pharmacoeconomics Department, Pfizer S.L.U., Alcobendas, Madrid, Spain

5 Medical Documentation Department, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain

6 Microbiology Department, School of Medicine, Universidad Complutense, Madrid, Spain

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Citation and License

BMC Infectious Diseases 2012, 12:283  doi:10.1186/1471-2334-12-283

Published: 1 November 2012

Abstract

Background

Community-acquired pneumonia (CAP) has large impact on direct healthcare costs, especially those derived from hospitalization. This study determines impact, clinical characteristics, outcome and economic consequences of CAP in the adult (≥18 years) population attended in 6 primary-care centers and 2 hospitals in Badalona (Spain) over a two-year period.

Methods

Medical records were identified by codes from the International Classification of Diseases in databases (January 1st 2008-December 31st 2009).

Results

A total of 581 patients with CAP (55.6% males, mean age 57.5 years) were identified. Prevalence: 0.64% (95% CI: 0.5%-0.7%); annual incidence: 3.0 cases/1,000 inhabitants (95% CI: 0.2-0.5). Up to 241 (41.5%) required hospitalization. Hospital admission was associated (p<0.002) with liver disease (OR=5.9), stroke (OR=3.6), dementia (OR=3.5), COPD (OR=2.9), diabetes mellitus (OR=1.9) and age (OR=1.1 per year). Length of stay (4.4±0.3 days) was associated with PSI score (β=0.195), in turn associated with age (r=0.827) and Charlson index (r=0.497). Microbiological tests were performed in all inpatients but only in 35% outpatients. Among patients with microbiological tests, results were positive in 51.7%, and among them, S pneumoniae was identified in 57.5% cases. Time to recovery was 29.9±17.2 days. Up to 7.5% inpatients presented complications, 0.8% required ICU admission and 19.1% readmission. Inhospital mortality rate was 2.5%. Adjusted mean total cost was €2,332.4/inpatient and €698.6/outpatient (p<0.001). Patients with pneumococcal CAP (n=107) showed higher comorbidity and hospitalization (76.6%), higher PSI score, larger time to recovery and higher overall costs among inpatients.

Conclusions

Strategies preventing CAP, thus reducing hospital admissions could likely produce substantial costs savings in addition to the reduction of CAP burden.

Keywords:
Community-acquired pneumonia; Streptococcus pneumoniae; Primary care setting; Hospital setting; Resource utilization; Health costs