A five-year study of severe community-acquired pneumonia with emphasis on prognosis in patients admitted to an intensive care unit

“…Although specific CAP aetiologies, such as K. pneumoniae, are frequently suspected of being associated with a higher mortality rate, these aetiologies have not been shown to constitute a prognostic factor for mortality [23][24][25][26].…”

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confidence: 99%

Severe community-acquired pneumonia: assessment of microbial aetiology as mortality factor

Paganin¹

2004

Eur Respir J

143

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Community-acquired pneumonia (CAP) remains a major cause of mortality. The aetiology of CAP has rarely been identified as a mortality risk factor. A prospective study was conducted to assess the prognostic factors of CAP patients admitted to the intensive care unit (Centre Hospitalier Departmental Félix Guyon, St Denis de la Réunion, France), with a special emphasis on microbial aetiology.All variables assessing severity were collected, with a special emphasis on microbial investigations. Among 112 immunocompetent patients (mean¡SD age 54.7¡15.1 yrs), 84% were male. Severity of CAP was demonstrated by mortality rate (43%), shock (48%), simplified acute physiology score (SAPS; 46.4¡21.6) and mechanical ventilation support (82%). Mean risk factor score was 2.2¡1.2. Microbiological identification was obtained in 78.6% of cases, with positive blood culture in 33%. Most frequently, microbial agents were Streptococcus pneumoniae and Klebsiella pneumoniae (42% and 22%, respectively).The univariate analysis recorded the usual mortality variables: age, alcohol consumption, SAPS, shock, mechanical ventilation, positive end expiratory pressure level, positive blood culture, multilobar infiltrates on chest radiograph, neutropenia, and acidosis, and found K. pneumoniae (versus S. pneumoniae, and all CAP) as a mortality factor. The multivariate analysis demonstrated that septic shock (relative risk (RR) 141), K. pneumoniae CAP (RR 27), SAPS (RR 10.7) and positive blood culture (RR 2.7) were independent factors related to death.In conclusion, the present study found that the microbial aetiology, Klebsiella pneumoniae, was an independent risk factor for mortality in severe community-acquired pneumonia.

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“…지역획득폐렴으로 입원한 환자의 약 10 %는 중환자실 입원이 필요한 중증지역획득폐렴으로 약 20-50 %의 높은 사망률을 보여주고 있다 7,8 . 외국의 경우 중증지역획득폐렴의 원인균으로 S. pneumoniae, Legionella, H. influenza, S. aureus가 흔하며 [9][10][11] , 기 관지확장증이 동반된 경우 P. aeruginosae가 흔한 원 인균으로 보고되고 있다 [11][12][13] . 국내에서는 중증지역획 참 고 문 헌…”

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The Etiologies and Initial Antimicrobial Therapy Outcomes in One Tertiary Hospital ICU-admitted Patient with Severe Community-acquired Pneumonia

et al. 2005

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Background : Several national societies have published guidelines for empirical antimicrobial therapy in patients with severe community-acquired pneumonia (SCAP). This study investigated the etiologies of SCAP in the Asan Medical Center and assessed the relationship between the initial empirical antimicrobial regimen and 30 day mortality rate. Method : retrospective analysis was performed on patients with SCAP admitted to the ICU between March 2002 and February 2004 in the Asan Medical Center. The basic demographic data, bacteriologic study results and initial antimicrobial regimen were examined for all patients. The clinical outcomes including the ICU length of stay, the ICU mortality rate, and 30 days mortality rates were assessed by the initial antimicrobial regimen. Results : One hundred sixteen consecutive patients were admitted to the ICU (mean age 66.5 years, 81.9 % male, 30 days mortality 28.4 %). The microbiologic diagnosis was established in 58 patients (50 %). The most common pathogens were S. pneumoniae (n=12), P. aeruginosae (n=9), K. pneumonia (n=9) and S. aureus (n=8). The initial empirical antimicrobial regimens were classified as: β-lactam plus macrolide; β-lactam plus fluoroquinolone; anti-Pseudomonal β-lactam plus fluoroquinolone; Aminoglycoside combination regimen; β-lactam plus clindamycin; and β-lactam alone. There were no statistical significant differences in the 30-day mortality rate according to the initial antimicrobial regimen (p = 0.682). Multivariate analysis revealed that acute renal failure, acute respiratory distress syndrome and K. pneumonae were independent risk factors related to the 30 day mortality rate. Conclusion : S. pneumoniae, P. aeruginosae, K. pneumonia and S. aureus were the most common causative pathogens in patients with SCAP and K. pneumoniae was an independent risk factor for 30 day mortality. The initial antimicrobial regimen was not associated with the 30-day mortality. (Tuberc Respir Dis 2005; 59: 522-529)

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A five-year study of severe community-acquired pneumonia with emphasis on prognosis in patients admitted to an intensive care unit

Abstract: The effectiveness of the initial therapy appears to be the most significant prognosis factor and, as the one and only related to the initial medical intervention, suggests a need for permanent optimization of our antimicrobial strategies.

Cited by 274 publications

References 21 publications

Guidelines for the management of adult lower respiratory tract infections

Guidelines for the management of adult lower respiratory tract infections

Severe community-acquired pneumonia: assessment of microbial aetiology as mortality factor

The Etiologies and Initial Antimicrobial Therapy Outcomes in One Tertiary Hospital ICU-admitted Patient with Severe Community-acquired Pneumonia

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