Patients with community acquired pneumonia admitted to European intensive care units: an epidemiological survey of the GenOSept cohort

Walden, Andrew; Clarke, Geraldine M.; McKechnie, Stuart; Hutton, Paula; Gordon, Anthony; Rello, Jordi; Chiche, Jean‐Daniel; Stueber, Frank; Garrard, Christopher S.; Hinds, C. J.

doi:10.1186/cc13812

Cited by 128 publications

(99 citation statements)

References 45 publications

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“…These patients had considerably higher mortality rates and longer lengths of stay compared to patients without SARI. The in-hospital mortality rate in our cohort was similar to rates reported in patients with severe community-acquired pneumonia in previous studies [17,20,30]. This can be explained by the frequent occurrence of organ failure in these patients.…”

Section: Discussionsupporting

confidence: 89%

“…Repeated outbreaks of SARI-related epidemics represent a major healthcare problem [1][2][3][4]. Several studies have investigated the epidemiology and clinical characteristics of SARI, with a special emphasis on viral etiology [13][14][15][16][17] or on the subset of patients admitted to the ICU with severe community-acquired pneumonia [17][18][19][20][21][22]. To the best of our knowledge, our study is the first to investigate this issue in a large prospective, multinational cohort of critically ill patients with SARI, providing a global view of this condition worldwide.…”

Section: Discussionmentioning

confidence: 99%

“…Ortiz and collaborators [32] Hospital 12 (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23) Limitation of therapy in-hospital, n (%) DNR 72 (11.9) WH/WD 57 (9.4) about 28,000 adults are hospitalized for influenza-associated critical illness in the USA annually. A recent biasadjusted meta-analysis [33] confirmed that influenza vaccine was effective in preventing hospitalization from influenza and/or pneumonia and all-cause mortality in community-dwelling elderly.…”

Section: Discussionmentioning

confidence: 99%

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The Intensive Care Global Study on Severe Acute Respiratory Infection (IC-GLOSSARI): a multicenter, multinational, 14-day inception cohort study

Sakr¹,

Ferrer

Reinhart³

et al. 2016

Intensive Care Med

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Purpose: In this prospective, multicenter, 14-day inception cohort study, we investigated the epidemiology, patterns of infections, and outcome in patients admitted to the intensive care unit (ICU) as a result of severe acute respiratory infections (SARIs). Methods:All patients admitted to one of 206 participating ICUs during two study weeks, one in November 2013 and the other in January 2014, were screened. SARI was defined as possible, probable, or microbiologically confirmed respiratory tract infection with recent onset dyspnea and/or fever. The primary outcome parameter was in-hospital mortality within 60 days of admission to the ICU. Results:Among the 5550 patients admitted during the study periods, 663 (11.9 %) had SARI. On admission to the ICU, Gram-positive and Gram-negative bacteria were found in 29.6 and 26.2 % of SARI patients but rarely atypical bacteria (1.0 %); viruses were present in 7.7 % of patients. Organ failure occurred in 74.7 % of patients in the ICU, mostly respiratory (53.8 %), cardiovascular (44.5 %), and renal (44.6 %). ICU and in-hospital mortality rates in patients with SARI were 20.2 and 27.2 %, respectively. In multivariable analysis, older age, greater severity scores at ICU admission, and hematologic malignancy or liver disease were independently associated with an increased risk of in-hospital death, whereas influenza vaccination prior to ICU admission and adequate antibiotic administration on ICU admission were associated with a lower risk.*Correspondence: yasser.sakr@med.uni-jena.de 1 Department of Anesthesiology and Intensive Care, Uniklinikum Jena, Erlanger Allee 103, 07743 Jena, Germany Full list of author information is available at the end of the article Take-home message: Admission to the ICU for SARI is common and associated with high morbidity and mortality rates. We identified several risk factors for in-hospital death that may be useful for risk stratification in these patients.On behalf of the IC-GLOSSARI Investigators and the Trials Group of the European Society of Intensive Care (ESICM), Rue Belliard, 19, 1040 Brussels, Belgium. Email: research@esicm.org.A complete list of IC-GLOSSARI investigators is provided in the "Appendix". Conclusions:Admission to the ICU for SARI is common and associated with high morbidity and mortality rates. We identified several risk factors for in-hospital death that may be useful for risk stratification in these patients.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The Intensive Care Global Study on Severe Acute Respiratory Infection (IC-GLOSSARI): a multicenter, multinational, 14-day inception cohort study

Sakr¹,

Ferrer

Reinhart³

et al. 2016

Intensive Care Med

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“…FP was diagnosed at laparotomy as inflammation of the peritoneal membrane secondary to large bowel perforation and fecal contamination (18). CAP was defined as a febrile illness associated with cough, sputum production, breathlessness, leukocytosis, and radiological features of pneumonia acquired in the community or within 2 days of ICU admission (21,22).…”

Section: Methods Study Design and Participantsmentioning

confidence: 99%

Shared and Distinct Aspects of the Sepsis Transcriptomic Response to Fecal Peritonitis and Pneumonia

Burnham

Davenport

Radhakrishnan

et al. 2017

Am J Respir Crit Care Med

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186

206

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Rationale: Heterogeneity in the septic response has hindered efforts to understand pathophysiology and develop targeted therapies. Source of infection, with different causative organisms and temporal changes, might influence this heterogeneity.Objectives: To investigate individual and temporal variations in the transcriptomic response to sepsis due to fecal peritonitis, and to compare these with the same parameters in community-acquired pneumonia.Methods: We performed genome-wide gene expression profiling in peripheral blood leukocytes of adult patients admitted to intensive care with sepsis due to fecal peritonitis (n = 117) or community-acquired pneumonia (n = 126), and of control subjects without sepsis (n = 10). Measurements and Main Results:A substantial portion of the transcribed genome (18%) was differentially expressed compared with that of control subjects, independent of source of infection, with eukaryotic initiation factor 2 signaling being the most enriched canonical pathway. We identified two sepsis response signature (SRS) subgroups in fecal peritonitis associated with early mortality (P = 0.01; hazard ratio, 4.78). We defined gene sets predictive of SRS group, and serial sampling demonstrated that subgroup membership is dynamic during intensive care unit admission. We found that SRS is the major predictor of transcriptomic variation; a small number of genes (n = 263) were differentially regulated according to the source of infection, enriched for IFN signaling and antigen presentation. We define temporal changes in gene expression from disease onset involving phagosome formation as well as natural killer cell and IL-3 signaling.Conclusions: The majority of the sepsis transcriptomic response is independent of the source of infection and includes signatures reflecting immune response state and prognosis. A modest number of genes show evidence of specificity. Our findings highlight opportunities for patient stratification and precision medicine in sepsis.

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“…With respect to the in-hospital setting, persistently high mortality rates of CAP, which in developed countries have been reported to reach 17% and 27% at 4 weeks and 6 months post-intensive care unit (ICU) admission respectively, present an ongoing challenge (4).…”

Section: Introductionmentioning

confidence: 99%

Corticosteroids in the adjunctive therapy of community-acquired pneumonia: an appraisal of recent meta-analyses of clinical trials

Feldman¹

2016

J. Thorac. Dis.

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Improving the outcome of patients with community-acquired pneumonia (CAP) is an ongoing challenge, even in the setting of significant advances in antimicrobial chemotherapy and critical care.Recognition of the underlying involvement of inflammation-mediated organ dysfunction as a determinant of adverse outcomes in CAP has aroused intense interest in the protective potential of adjunctive antiinflammatory therapies in CAP, particularly the role of corticosteroids (CS). This is the primary topic of the current review which is focused on an evaluation of the latest meta-analyses encompassing both recent and earlier clinical trials, with particular emphasis on the stringent meta-analysis undertaken by Siemieniuk and colleagues (Ann Intern Med 2015;163:519-528). The review highlights the findings and recommendations of these and related published commentaries/critiques, while providing a brief description of those subgroups of patients who seemingly stand to benefit most from CS therapy. This is preceded by an overview of the mechanisms of the anti-inflammatory activities of CS, the interactions of these agents with macrolide antibiotics, and the potential benefits and risks of short-term administration of CS, concluding with a succinct appraisal of priority issues for ongoing and future research.

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Patients with community acquired pneumonia admitted to European intensive care units: an epidemiological survey of the GenOSept cohort

Cited by 128 publications

References 45 publications

The Intensive Care Global Study on Severe Acute Respiratory Infection (IC-GLOSSARI): a multicenter, multinational, 14-day inception cohort study

The Intensive Care Global Study on Severe Acute Respiratory Infection (IC-GLOSSARI): a multicenter, multinational, 14-day inception cohort study

Shared and Distinct Aspects of the Sepsis Transcriptomic Response to Fecal Peritonitis and Pneumonia

Corticosteroids in the adjunctive therapy of community-acquired pneumonia: an appraisal of recent meta-analyses of clinical trials

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