PLACE OF MANAGEMENT, ETIOLOGY AND TREATME NT OF THE COMMUNITY-ACQUIRED PNEUMONIAS IN PALMA-DE-MALLORCA, SPAIN

BACKGROUND: It is not common that community-acquired pneumonias studie d include patients non treated in hospital, The objectives were: to de termine the cases managed in the ambulatory setting; to describe the c linical features; to identify the aetiological agents, and to describe the treatment, comparing inpatients with outpatients. PATIENTS AND ME THODS: Observational prospective study. Population attended at three t eaching primary care centers of Palma de Mallorca (60,450 habitants), Patients (> 14 years) were investigated when diagnosticated of communi ty acquired pneumoniae, from November 1992 to December 1994, Exclussio ns: HIV infection, patients living in a nursing home and tuberculosis. Data were collected in both Hospital and primary health care centers, Epidemiological, clinical, radiological and laboratory findings were recorded at the initial visit and 21 days after, RESULTS: 91 cases wer e investigated. 57% were managed at the primary care centers exclusive ly, 63.3% of the patients who went initially to the: hospital were adm itted inr but only 10.9% of those who went initially to the primary ca re centers (p < 0.005). 24 patients were hospitalized. 56 microbiologi cal agents were identified in 48 patients (52.7%): Mycoplasma pneumoni ae(10); Streptococcus pneumoniae(9); influenza B (8); Chlamydia psitta cci (7); Influenza A (7); Coxiella burnetii (5); Chlamydia pneumoniae( 4); Legionella (3); Adenovirus (2); and Parainfluenza 3 (1). Mycoplasm a was predominant in outpatients: 9 cases, S. pneumoniae in inpatients : 5 cases, Eritromycin was the most common treatment prescribed (76.9% of patients), alone or in combination with other antibiotics, Monothe rapy was most common at primary care yield (96.7%) than at the hospita l (45.2%) (p.:0.005). CONCLUSIONS: Most Of the patients with community acquired pneumonias are managed at primary health care centers, M. pn eumoniae is the predominant microbiological agent in outpatients and S . pneumoniae in inpatients. Erithromycin is the most used antibiotic i n both groups of patients.