Exame do escarro no manejo clínico dos pacientes com pneumonia adquirida na comunidade Sputum examination in the clinical management of community-acquired pneumonia

OBJETIVO: Este estudo retrospectivo avaliou a freqüência do uso da bacteriologia do escarro no manejo clínico de pacientes com pneumonia adquirida na comunidade (PAC) em um hospital geral, e se a utilização deste método modificou a mortalidade. MÉTODOS: Os prontuários de pacientes internados no Hospital Nossa Senhora da Conceição, em Porto Alegre (RS) Brasil, para tratamento de PAC entre maio e novembro de 2004 foram revisados quanto aos seguintes aspectos: idade; sexo; gravidade da pneumonia (escore de Fine); presença de expectoração; bacteriologia do escarro; história de tratamento; resposta clínica; troca de tratamento; e mortalidade. RESULTADOS: Foram avaliados 274 pacientes com PAC, sendo 134 do sexo masculino. Dentre os 274 pacientes, 79 (28,8%) apresentavam, de acordo com o escore de Fine, classe II; 45 (16,4%), classe III; 97 (35,4%), classe IV; e 53 (19,3%), classe V. Em 92 pacientes (33,6%), uma amostra de escarro foi colhida para exame bacteriológico. Obtivemos amostra válida em 37 casos (13,5%) e diagnóstico etiológico em 26 (9,5%), o que resultou em modificação do tratamento em apenas 9 casos (3,3%). A mortalidade geral foi 18,6%. Idade acima de 65 anos, a gravidade da PAC e a ausência de escarro associaram-se à maior mortalidade. A bacteriologia do escarro não influenciou o desfecho clínico, nem a taxa de mortalidade. CONCLUSÃO: O exame do escarro foi uma ferramenta diagnóstica utilizada na minoria dos pacientes, e não trouxe benefício detectável no manejo clínico dos pacientes com PAC tratados em ambiente hospitalar.<br>OBJECTIVE: To evaluate the frequency of the use of sputum examination in the clinical management of community-acquired pneumonia (CAP) in a general hospital and to determine whether its use has an impact on mortality. METHODS: The medical records of CAP patients treated as inpatients between May and November of 2004 at the Nossa Senhora da Conceição Hospital, located in Porto Alegre, Brazil, were reviewed regarding the following aspects: age; gender; severity of pneumonia (Fine score); presence of sputum; sputum bacteriology; treatment history; change in treatment; and mortality. RESULTS: A total of 274 CAP patients (134 males and 140 females) were evaluated. Using the Fine score to quantify severity, we classified 79 (28.8%) of those 274 patients as class II, 45 (16.4%) as class III, 97 (35.4%) as class IV, and 53 (19.3%) as class V. Sputum examination was carried out in 92 patients (33.6%). A valid sample was obtained in 37 cases (13.5%), and an etiological diagnosis was obtained in 26 (9.5%), resulting in a change of treatment in only 9 cases (3.3%). Overall mortality was 18.6%. Advanced age (above 65), CAP severity, and dry cough were associated with an increase in the mortality rate. Sputum examination did not alter any clinical outcome or have any influence on mortality. CONCLUSION: Sputum examination was used in a minority of patients and was not associated with any noticeable benefit in the clinical management of patients with CAP treated in a hospital setting

Frailty in old Age is associated with altered cytokine production in response to TLR ligation

Older people display increasing rates and severity of infections and reduced vaccine responses. The innate immune system is the first line of defense that protects the host from invading pathogens. Recognition of microbial components by Toll-Like Receptor (TLR)-dependent activation of antigen-presenting cells, such as dendritic cells, macrophages, or monocytes, is a crucial step for the ensuing initiation of the adaptive immune response. Several studies suggest that cytokine production upon stimulation by TLR ligands are affected in older individuals. Herein we discuss the different mechanisms that could account for the alterations of TLR-responsiveness in the geriatric population, focusing on the clinical characteristics of this age group. We suggest that frailty-associated factors, such as malnutrition, dysbiosis, and neurohormonal changes, could limit cytokine production by myeloid cells thereby contributing to immunosenescence.info:eu-repo/semantics/publishe