Dados do Trabalho

Título

Characteristics and outcomes of adult patients with community-acquired pneumonia admitted to intensive care units in middle- and low-income countries – a systematic review.

Objetivo

Describe short-term mortality, clinical characteristics, ICU resource utilization of Severe community-acquired pneumonia (sCAP) patients admitted to ICU in Low and middle-income countries (LMIC).

Métodos

Terms related to sCAP, ICU and LMIC were searched in PubMed and 6 other bases from 01/01/2002 to 05/02/2024. Exclusion criteria: Lack of core data, non-ICU population, or studies of a single pathogen. Primary outcome was ICU mortality and we also described clinical characteristics and resource use. PROSPERO: CRD42022363048.

Resultados

The search retrieved 17020 citations. After duplicates removal and abstract selection there were 451 papers elected for detailed triage. 51 studies were included. There were no publications from LIC, and 45 were from Upper-Middle Income Countries. 49342 patients were included and ICU mortality was 37.09%. Mechanical ventilation was used by 59.8% (+/- 24.8) patients. Streptococcus pneumoniae was the most frequent agent isolated (17%). Economic categorization was not related to outcome, and older age was identified as a risk for higher mortality. Most frequent comorbidities were arterial hypertension, chronic obstructive pulmonary disease and diabetes. Pneumonia Severity Index was the risk stratification tool more frequently cited (mean 135 +/- 25.4), and APACHE was the most frequent reported severity score (mean 18.5 +/- 4.26).

Conclusão

Despite the importance of sCAP, no studies from LIC were found. This represents a gap in the literature. In MICs, mortality and resource use are high, but data is relatively poor considering the burden of sCAP. New studies with better characterization of sCAP in LMICs are mandatory to improve the knowledge and drive improvements in care delivery.