Adherence to Community Acquired Pneumonia guideleines and patients outcomes in a peri-urban hospital in Natal, South Africa

Abstract

Introduction: Community-acquired pneumonia (CAP) is an important cause of mortality and morbidity worldwide. This issue is further exacerbated by the Human Immunodeficiency Virus (HIV) epidemic.

Methodology: The study was a retrospective, clinical record review of hospitalized patients (18 years and older) with a diagnosis of LRTI between the 1st of January 2012 and 31 December 2012, descriptive and comparable analysis was performed.

Results: Number of patients was 274; 142 (51.8%) males. The commonest final diagnosis was Pulmonary Tuberclosis (PTB) in 131 (47.8%) and CAP in 127 (46.4%). The case fatality rate was 25.5% (70/274) and was significantly associated with HIV infection (77.4%) (p < 0,01), CD4 cell count ≤ 200 cells (96.3), final diagnosis of TB (65.7%) (p < 0.01), female sex (57%) (p < 0.01), confusion (50%) (p < 0.01), age of 65 years or more (29%) (p < 0.01). CURB-65 score (Confusion, Urea more than 7mmol/l, Respiratory rate (RR) ≥30 breaths /min, low blood pressure (less than 90 mmHg systolic and 60mmHg diastolic) and age ≥ 65 years) was only documented in 4 % (11/274) patients. Only 63 patients (23%) met the admission criteria of two or more points when the CURB-65 score was calculated.

Conclusions: Failure to use the CURB-65 score resulted in an increase admission of patients presenting with LRTI. There was an increased case fatality rate in this high HIV prevalence setting.