Mortality in ICU patients with bacterial community-acquired pneumonia: when antibiotics are not enough

Rodríguez, Alejandro; Lisboa, Thiago; Blot, Stijn; Martín‐Loeches, Ignacio; Solé-Violán, J.; Mendoza, Diego de; Rello, Jordi

doi:10.1007/s00134-008-1363-6

Cited by 73 publications

(52 citation statements)

References 34 publications

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“…Currently, pneumonia guidelines do not emphasise the importance of achieving time-sensitive resuscitation targets in SCAP, although sepsis studies [21,23,24] have consistently demonstrated this to be effective in reducing mortality. Conflicting evidence also exists regarding the usefulness of early antibiotics for SCAP [1,25]. Logically, to achieve outcome improvements, identifying SCAP patients early would not suffice; thus, the pragmatic incorporation of a resuscitation bundle might have improved the outcomes significantly.…”

Section: Respiratory Infections | Hf Lim Et Almentioning

confidence: 99%

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IDSA/ATS minor criteria aid pre-intensive care unit resuscitation in severe community-acquired pneumonia

et al. 2013

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The effect of employing severity scores to identify severe community-acquired pneumonia (SCAP) cases for early aggressive resuscitation is unknown. Optimising pre-intensive care unit (ICU) care may improve outcomes in patients at risk of SCAP.We conducted a before-and-after study of patients classified into control and intervention groups (January 2004 to December 2007 and January 2008 to December 2010, respectively). Our intervention was two-pronged, using the 2007 Infectious Diseases Society of America (IDSA)/American Thoracic Society (ATS) minor criteria to identify SCAP for aggressive emergency department resuscitation. Patients with SCAP, defined as those with three or more IDSA/ATS minor criteria, were targeted. Differences in mortality, triage and compliance with emergency department resuscitation were compared between the groups.The hospital mortality rate was lower in the intervention versus the control group (5.7% versus 23.8%, p,0.001). On multivariate analysis, the intervention group was associated with lower mortality (OR 0.24, 95% CI 0.09-0.67). ICU admission rates decreased from 52.9% to 38.6% (p50.008) and inappropriately delayed ICU admissions decreased from 32.0% to 14.8% (p,0.001). There was increased compliance with the aggressive resuscitation protocol after the intervention.A combined intervention, using a pneumonia score to identify those at risk of SCAP early and an aggressive pre-ICU resuscitation protocol may reduce mortality and ICU admissions. @ERSpublications IDSA/ATS minor criteria can help identify at-risk SCAP patients for early resuscitation

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Section: Respiratory Infections | Hf Lim Et Almentioning

confidence: 99%

“…Severe community-acquired pneumonia (SCAP) is associated with a high mortality rate (23-50%) and can result in significant healthcare costs [1][2][3]. It is usually defined as community-acquired pneumonia (CAP) that requires intensive care unit (ICU) admission or mechanical ventilation/vasopressor support.…”

Section: Introductionmentioning

confidence: 99%

IDSA/ATS minor criteria aid pre-intensive care unit resuscitation in severe community-acquired pneumonia

et al. 2013

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“…La morbilidad de la decorticación pleuropulmonar por toracotomía puede alcanzar hasta el 30% y la mortalidad al 10%. Las complicaciones más frecuentemente descritas son fístulas broncopleurales, infección de herida operatoria, hemorragias post operatorias y cavidades residuales 1,3,[7][8][9][10]12,[35][36][37][38] . Otras técnicas como la fenestración o la toracoplastía, se dejan para casos extremos en que las otras alternativas quirúrgicas no logran el objetivo de tratar la infección y lograr expansión pulmonar evitando cavidades residuales, de ser posible, deben evitarse ya que se asocian con un deterioro significativo en la calidad de vida de los pacientes 3,10,[29][30][31] .…”

Section: Discussionunclassified

“…El EP en series quirúrgicas mantiene una morbilidad y mortalidad considerables, la morbilidad puede alcanzar el 30% y la mortalidad el 20% en grupos de riesgo [1][2][3][4][5][6][7][8][9]11,38 . Nuestra serie de pacientes globalmente tiene una morbilidad de 30,3% y una mortalidad de 9,0%.…”

Section: Discussionunclassified

Empiema pleural en 343 casos con tratamiento quirúrgico: características, resultados inmediatos y factores asociados a morbilidad y mortalidad

et al. 2012

Rev Chil Cir

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Pleural empyema. Retrospective review of 343 patientsBackground: Pleural empyema still has a dismal prognosis. Aim: To describe features and prognostic factors of patients with pleural empyema subjected to surgical procedures. Material and Methods: Retrospective review of 343 patients with pleural empyema (mean age 52 years, 71% males), that were subjected to any type of surgical procedure. Criteria for diagnosis of empyema were a positive culture, a fluid pH of less than 7.2 or a compatible macroscopic appearance of the fluid. Results: Empyema was secondary to pneumonia in 243 patients (71%), secondary to surgical procedures in 41 patients (12%), secondary to trauma in 19 patients (5.5%), secondary to a lung abscess in 10 patients (3%), tuberculous in 10 patients (3%), neoplastic in two cases (0.6%), secondary to pneumothorax in 2 cases (0.6%) and of unknown origin in 13 patients (4%). A microorganism was isolated from pleural fluid in 89 patients (26%). The surgical procedures performed were 251 decortications by thoracotomy (73%), 70 pleurotomies (20%), 11 video assisted surgeries (3%), seven decortications with lung resections and four fenestrations. Complications were recorded in 104 patients (30%), 29 patients were re-operated (8.5%) and 31 died (10%), all due to sepsis. Conclusions: The main cause of pleural empyema is pneumonia. In most patients, microorganisms are not isolated from pleural fluid, thoracotomy with decortication is the most frequent surgical procedure. There is a high rate of complications and mortality.

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“…In this issue of intensive care medicine, Rodriguez et al [6] are reporting non-immunocompromised patients from the CAPUCCI study suffering from severe bacterial CAP (122 S. pneumoniae, 90 non-S. pneumonia pathogens) and receiving adequate antibiotic therapy. Despite appropriate antibiotic therapy of 184 patients with an etiological diagnosis, 43 (23.4%) patients died; risk factors for a fatal outcome in the multivariate analysis were shock (OR 13.0), acute renal failure (OR 4.8) and APACHE II-Score [24 (OR 2.2).…”

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confidence: 99%

Bacterial community-acquired pneumonia: risk factors for mortality and supportive therapies

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2008

Intensive Care Med

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Mortality in ICU patients with bacterial community-acquired pneumonia: when antibiotics are not enough

Cited by 73 publications

References 34 publications

IDSA/ATS minor criteria aid pre-intensive care unit resuscitation in severe community-acquired pneumonia

IDSA/ATS minor criteria aid pre-intensive care unit resuscitation in severe community-acquired pneumonia

Empiema pleural en 343 casos con tratamiento quirúrgico: características, resultados inmediatos y factores asociados a morbilidad y mortalidad

Bacterial community-acquired pneumonia: risk factors for mortality and supportive therapies

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