Salluh Jorge I F, Lisboa Thiago, Bozza Fernando A, Soares Márcio, Póvoa Pedro
D'or Institute for Research and Education, Rio de Janeiro, Brazil; Postgraduation Program, Instituto Nacional de Câncer, Rio de Janeiro, Brazil.
Intensive Care Unit and Infection Control Committee, Hospital das Clínicas, Postgraduation Program Pneumology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Rede Institucional de Pesquisa e Inovação em Medicina Intensiva (RIPIMI)-Complexo Hospitalar Santa Casa, Porto Alegre, Brazil.
J Crit Care. 2014 Oct;29(5):743-7. doi: 10.1016/j.jcrc.2014.05.019. Epub 2014 May 29.
The purpose of this study is to characterize the practices of pulmonary, internal medicine, and critical care physicians toward the management of patients with severe community-acquired pneumonia (CAP).
A cross-sectional international anonymous survey was conducted among a convenience sample of critical care, pulmonary, emergency, and internal medicine physicians from Portugal, Spain, and South America between October and December 2008. The electronic survey evaluated physicians' attitudes toward diagnosis, risk assessment, and therapeutic interventions for patients with severe CAP.
Four hundred sixty-eight physicians responded being 84.6% from 4 countries (Brazil, Portugal, Spain, and Argentina) whom 66.9% had more than 10 years experience. Risk assessment of severe CAP was very heterogeneous being clinical evaluation the most frequent. Although blood cultures were recognized as presenting a poor diagnostic performance, they were performed by 77.1%. In opposition, the presence of urinary pneumococcal and Legionella antigen was asked by less than one-third of physicians. The great majority (95%) prescribes antibiotics according to a guideline being the combination of β-lactam plus macrolide the most frequent choice.
Despite the recent advances of knowledge reflected in the present study in the management of severe CAP, several of them are still incompletely translated into clinical practice. Significant variation in practice is observed among physicians and represents a potential target for future research and educational interventions.
本研究旨在描述肺科、内科和重症医学科医生对重症社区获得性肺炎（CAP）患者的管理实践。
2008年10月至12月间，对来自葡萄牙、西班牙和南美洲的重症医学、肺科、急诊科和内科医生的便利样本进行了一项横断面国际匿名调查。电子调查问卷评估了医生对重症CAP患者的诊断、风险评估和治疗干预的态度。
468名医生做出回应，其中84.6%来自4个国家（巴西、葡萄牙、西班牙和阿根廷），66.9%的医生有超过10年的经验。重症CAP的风险评估差异很大，临床评估最为常见。尽管血培养的诊断性能较差，但仍有77.1%的医生进行血培养。相反，不到三分之一的医生会检测尿肺炎球菌和军团菌抗原。绝大多数（95%）医生根据指南使用抗生素，最常用的选择是β-内酰胺类加大环内酯类联合用药。
尽管本研究中反映出在重症CAP管理方面的知识有了最新进展，但其中一些进展仍未完全转化为临床实践。医生之间的实践存在显著差异，这是未来研究和教育干预的潜在目标。
