Pneumonia adquirida na comunidade numa unidade de cuidados intensivos

Abstract

Community-acquired pneumonia (CAP) is the leading cause of sepsis in adult critical care. We present a retrospective study of patients admitted to a polyvalent intensive care unit with CAP from 1st June 2004 - 31st December 2006. We analysed 76 patients with a mean age of 62.88 (18.75) years. Mean APACHE II score was 24.88 (9.75). Mean SAPS II was 51.18 (18.05), with a predicted mortality of 47.27%. Aetiology was identified in 42.1% of the patients. Streptococcus pneumoniae was the most frequent aetiological agent, but the group of aetiological agents more frequently identified was Gram-negative enteric bacilli. Levofloxacine was the most frequently previously used antibio tic. The most frequently used antibiotherapy scheme was the association ceftriaxone - azithromicine. It was possible to evaluate suitability of treatment in 32 patients; 27 were on suitable antibiotherapy regimes. 66 patients (86.8%) were on respirators, with a median length of 4 days. The median length of stay was 5.3 days. ICU mortality was 36.8% and hospital mortality 55.26%. SAPS II, CRP (C-reactive protein), potassium and initial unsuitable antibiotherapy were related to mortality. After multivariate analysis, only SAPS II maintained statistical significance. Use of antibiotics should be judicious, taking the most frequent agents and their susceptibility into consideration.

Primary immune deficiency in the intensive care unit: It is never too late to diagnose and treat

“…Recurrent RTIs are the most common manifestation in CVIDs,[348] complicated with sequelae like chronic sinusitis, lung fibrosis, and bronchiectasis (12.2%). [6] Granulomatous Interstitial Lung Disease can shorten survival in CVIDs.…”

“…ICU mortality of severe pneumonias was 36.8% in one series. [8] PIDs may easily be missed as a cause of NRPs, as other causes (malnutrition, HIV infection, tuberculosis, inappropriate use of antibiotics) are common, while the exact incidence of CVIDs is unknown, although it is the most common PID encountered in clinical practice. [2411]…”