Resumen en Español :
Objetivo: Comparar características clínicas-epidemiológicas de las neumonías
intrahospitalarias precoces (NIHp) y tardías (NIHt).
Material y métodos: Estudio prospectivo, observacional y comparativo de 76 NIH internadas en Servicio de Clínica Médica, Hospital Lagomaggiore, Mendoza. Periodo 4/2022-9/2024.
NIH: infección que afecta al parénquima pulmonar, que se manifiesta transcurridas las 48 hs del
ingreso del paciente al hospital. NIHp: se desarrolla entre 2-7 días de ingreso al nosocomio y NIHt a partir del séptimo día. Eventos adversos serios relacionados (EASR): UTI, shock séptico, necesidad de vasopresores, asistencia respiratoria mecánica (ARM) y mortalidad hospitalaria. Análisis comparativo: NIHp vs NIHt. Análisis estadístico: medidas de tendencia central, análisis univariado: test de Student, criterio de significación de α<5%. Resultados: Tuvieron NIHp 40 (52.63%). Comparativamente las NIHp fueron varones 23 (57.5%) vs 22 (61.1%) p0.7, edad 53.7 años ±18.8 vs 53.5 ±16.2 p0.9, edad >65 años: 13 (32.5%) vs 12 (33.3%) p0.9. Estadía hospitalaria 11 (8-14) vs 34 (20–50) p<0.05. Comórbidas: ACV 5 (38.5%) vs 8 (61.5%) p0.23, EPOC 9 (22.5%) vs 3 (8.3%) p0.1, DM 5 (12.5%) vs 10 (27.8%) p0.1, hepatopatía 3 (7.5%) vs 2 (5.6%) p0.7, ERC 2 (5%) vs 5 (13.9%) p0.2, desnutrición 5 (12.5%) vs 6 (16.7%) p0.6. Trastorno deglutorio 7 (17.5%) vs 13 (36.1%) p0.1. Tabaquismo 23 (57.5%) vs 15 (41.7%) p0.2 y enolismo 4 (10%) vs 2 (5.6%) p0.5.
Manifestaciones clínicas: taquicardia 28 (70%) vs 25 (69.4%) p0.8, taquipnea 25 (62.5%) vs 27 (75%) p0.2, fiebre 14 (35%) vs 22 (61.1%) p0.02 y trastorno de conciencia 9 (22.5%) vs 6 (16.7%) p0.5. Laboratorio: leucocitos (cel/mm3) 13787 ±6641 vs
12472 ±5594 p0.35, PCR (mg/dl) 138.3 ±106 vs 129.5 ±93 p0.04, creatinina (mg/dl) 1.11 ±1.2 vs 1.79 ±3.7 p0.03. Aislamiento por episodio: SAMR 3 (7.7%) vs 0 (0%) p0.08, Streptococcus pneumoniae 2 (5%) vs 2 (5.6%) p0.9, Klebsiella pneumoniae 1 (2.5%) vs 5 (13.9%) p0.06 y Pseudomonas aeruginosa 0 (0%) vs 4 (11.1%), p0.03. Tuvieron bacteriemia 5 (12.5%) vs 9 (25%) p0.2. Complicaciones: insuficiencia respiratoria 29
(72.5%) vs 30 (83.3%) p0.25, ARM 7 (17.5%) vs 15 (41.7%) p0.02, vasopresores 4 (10%) vs 15 (41.7%) p0.001 y necesidad de UTI 10 (25%) vs 21 (58.3%) p0.003. EASR 18 (45%) vs 24 (66.7%), p0.05. qSOFA >2: 12 (30%) vs 17 (47.2%) p0.1 y SOFA >2: 25
(62.5%) vs 31 (86.1%), p0.01. Letalidad hospitalaria fue 11 (14.5%): 6 (15%) vs 5 (13.9%) p0.9.
Conclusión: Las NIH tardías se asociaron a estancia hospitalaria prolongada, con puntajes más altos de gravedad desarrollando más complicaciones como la necesidad de pase unidad de terapia intensiva por requerimiento de asistencia respiratoria mecánica y/o vasopresores. Las NIH precoces tuvieron mayor respuesta inflamatoria por reactantes de fase aguda mientras que las tardías desarrollaron con más frecuencia fallo renal.
Resumen en Inglés :
Objective: To compare clinical-epidemiological characteristics of early (EHAP) and late (LHAP) hospital-acquired pneumonia.
Materials and methods: prospective, observational and comparative study of 76 hospital-acquired pneumonia (HAP) admitted to the Internal Medicine Service, Lagomaggiore Hospital, Mendoza. From April 2022 to September 2024. Hospital-acquired pneumonia: infection that affects the lung parenchyma, which manifests itself 48 hours after the patient is admitted to the hospital.
EHAP: develops between 2-7 days of admission to the hospital and LHAP from the seventh day. Related serious adverse events (SAEs): ICU, septic shock, need for vasopressors and mechanical ventilation (MV), and in-hospital mortality. Comparative analysis Group A: Early hospital-acquired pneumonia (EHAP) vs Group B: Late
hospital-acquired pneumonia (LHAP). Statistical analysis: measures of central tendency,
univariate analysis using Student's test, significance criterion of α<5%.
Results: 40 (52.63%) had EHAP. Comparatively, the EHAP were men 23 (57.5%) vs 22 (61.1%) p0.7, age 53.7 years ±18.8 vs 53.5 ±16.2 p0.9, age >65 years: 13 (32.5%) vs 12 (33.3%) p0.9. Hospital stay 11 (8-14) vs 34 (20-50) p<0.05. Comorbid: Stroke 5 (38.5%) vs 8 (61.5%) p0.23, COPD 9 (22.5%) vs 3 (8.3%) p0.1, DM 5 (12.5%) vs 10 (27.8%) p0.1, liver disease 3 (7.5%) vs 2 (5.6%) p0.7, CKD 2 (5%) vs 5 (13.9%) p0.2, malnutrition 5 (12.5%) vs 6 (16.7%) p0.6. Swallowing disorder 7 (17.5%) vs 13 (36.1%) p0.1. Smoking 23 (57.5%) vs 15 (41.7%) p0.2 and alcoholism 4 (10%) vs 2 (5.6%) p0.5. Clinical manifestations: tachycardia 28 (70%) vs 25 (69.4%) p0.8, tachypnea 25 (62.5%) vs 27 (75%) p0.2, fever 14 (35%) vs 22 (61.1%) p0.02 and altered mental status 9 (22.5%) vs 6 (16.7%) p0.5. Laboratory: leukocytes (cell/mm3) 13787 ±6641 vs 12472 ±5594 p0.35, CRP (mg/dl) 138.3 ±106 vs 129.5 ±93 p0.04, creatinine (mg/dl) 1.11 ±1.2 vs 1.79 ±3.7
p0.03. Microbial identification by episode: SAMR 3 (7.7%) vs 0 (0%) p0.08, Streptococcus pneumoniae 2 (5%) vs 2 (5.6%) p0.9, Klebsiella pneumoniae 1 (2.5%) vs 5 (13.9%) p0.06 and Pseudomonas aeruginosa 0 (0%) vs 4 (11.1%), p0.03. Bacteremia occurred in 5 (12.5%) vs 9 (25%) p0.2. Complications: respiratory failure 29 (72.5%) vs 30 (83.3%) p0.25, MV 7 (17.5%) vs 15 (41.7%) p0.02, vasopressors 4 (10%) vs 15 (41.7%) p0.001 and ICU admission 10 (25%) vs 21 (58.3%) p0.003. SAEs 18 (45%) vs 24 (66.7%), p0.05. qSOFA >2: 12 (30%) vs 17 (47.2%) p0.1 and SOFA >2: 25 (62.5%) vs 31 (86.1%), p0.01. Lethality was 11 (14.5%): 6 (15%) vs 5 (13.9%) p0.9
Conclusion: Late hospital-acquired pneumonia was associated with prolonged hospital stay, with higher severity scores developing more complications such as the admission to intensive care unit transfer due to mechanical ventilation and/or vasopressors. Early hospital-acquired pneumonia had a greater inflammatory response due to acute phase reactants while late hospital-acquired pneumonia more frequently developed renal failure.