Percorsi diagnostico-terapeutici nella gestione dei pazienti affetti da polmonite acquisita in comunità

Abstract

Community-Acquired Pneumonia (CAP) is one of the major cause of death due to infectious diseases in developed countries. In Italy, about 18% of the patients with CAP are hospitalized, accounting for an annual health-care cost of more than 1.000 billion Lire. Overall, CAP represents an heavy burden to the society and the National Health-Care System. The managed-care of patients with CAP should be committed to find a balance between the individual health-care needs and the more general claims of a fair utilization and an overall efficiency of the healthcare system. The comprehensive strategy of care should consider many decision nodes and the outcomes related with each different options. The diagnostic procedures (physical examination, chest radiography, microbiology, laboratory) should be oriented to obtain a robust differential diagnosis and to estimate the risk of mortality. Prediction rule are now available that help physicians to make more rational decisions about hospitalization for patients with pneumonia. The selection of antibiotic in the absence of an etiologic diagnosis is based on the epidemiological settings, the severity of the illness and other clinical conditions of the patients. Non concordant therapeutic recommendations are provided by the published guidelines. Decisions to be taken during the follow-up concern the switch therapy and the early discharge options, as soon as the patient stabilizes, or the admission to ICU in case of worsening. The length of hospital stay depends on the time to stability and the risk of mortality. However, socio-cultural factors and availability of outpatient care programs could facilitate the early discharge of patients and help to decrease the health-care costs of CAP patients. The results of the present review can be used as a background to implement a general decision model suitable to performe pharmacoeconomic analysis of the CAP therapy.