CAPPRIC Study—Characterization of Community-Acquired Pneumonia in Spanish Adults Managed in Primary Care Settings

Jesús Molina,Amelia González-Gamarra,Gonzalo Aldana,Cristina Méndez,Manuel Linares,Enriqueta Quesada,Marta Pedrol,Antonio Artuñedo,Agustina Cano,Javier López ,Jaime Gonzálvez ,Leovigildo Ginel ,Ma Encarnación Peláez ,Antonio Gómez ,Joan Josep Cabré ,Enrique Mascarós ,Federico Martinón‐Torres ,María Carmen Serra ,Pilar Yolanda Sanchez ,Isabel Cifuentes ,José Antonio Herrero ,María Teresa Herranz Marín ,Juan Vicente Alfaro ,Leonor Núñez ,Juan Luis Juez ,Juan Enrique Cimas Hernando ,Daniel Ocaña

doi:10.3390/microorganisms9030508

Abstract

The real burden of community-acquired pneumonia (CAP) in non-hospitalized patients is largely unknown. This is a 3-year prospective, observational study of ambulatory CAP in adults, conducted in 24 Spanish primary care centers between 2016–2019. Sociodemographic and clinical variables of patients with radiographically confirmed CAP were collected. Pneumococcal etiology was assessed using the Binax Now® test. Patients were followed up for 10 ± 3 days. A total of 456 CAP patients were included in the study. Mean age was 56.6 (±17.5) years, 53.5% were female, and 53.9% had ≥1 comorbidity. Average incidence of CAP was 1.2–3.5 cases per 1000 persons per year. Eighteen patients (3.9%) were classified as pneumococcal CAP. Cough was present in 88.1% of patients at diagnosis and fever in 70.8%. Increased pulmonary density (63.3%) and alveolar infiltrates with air bronchogram (16.6%) were the most common radiographic findings. After 14.6 ± 6.0 days (95% CI = 13.9–15.3), 65.4% of patients had recovered. Hospitalization rate was 2.8%. The most frequently prescribed antibiotics were quinolones (58.7%) and β-lactams (31.1%). In conclusion, one-third of CAP patients did not fully recover after two weeks of empiric antibiotic therapy and 2.8% required hospitalization, highlighting the significant burden associated with non-hospitalized CAP in Spain.

Highlights

Lower respiratory infections have been a leading global infectious cause of mortality in all age groups over the past twenty-five years [1]
Among 851 adult patients with community-acquired pneumonia (CAP) registered between April 2016 and April 2019 in 24 Spanish primary care centers, 524 patients were considered for inclusion in the study
We were able to obtain a current picture of ambulatory CAP patients by describing their clinical and demographic characteristics in addition to the treatments they received, showing that one in three patients does not recover within 7–10 days after starting antibiotic therapy

Summary

Introduction

Lower respiratory infections have been a leading global infectious cause of mortality in all age groups over the past twenty-five years [1]. Community-acquired pneumonia (CAP) is a major cause of morbidity and mortality worldwide, especially in the elderly. It is responsible for approximately 1 million hospital admissions yearly, producing a considerable impact on health care resources. In Spain the incidence of CAP in primary care patients ≥ 65 years was 24.8–94.8 per 1000 persons [4]. Most of these studies are based only on hospital data, the majority of CAP patients receive outpatient treatment [5]

Methods

Results

Conclusion