Severe Community-acquired Pneumonia: Epidemiology and Prognostic Factors

Abstract

Over a period of 4 consecutive yr, 92 nonimmunosuppressed patients (21 women and 71 men aged 53 +/- 16 yr, means = SD) with critical acute respiratory failure (PaO2/FiO2, 209 +/- 9 mm Hg) caused by severe community-acquired pneumonia were admitted to the respiratory intensive care unit (RICU) of a general hospital. The most frequent underlying clinical condition was chronic obstructive pulmonary disease (44 patients, 48%). A total of 56 patients (61%) required mechanical ventilation for a mean period of 10.7 +/- 12.5 days, 29 of them (52%) needing PEEP (9.9 +/- 3.8 cm H2O). A group of 23 (25%) patients had criteria of adult respiratory distress syndrome (ARDS). A causal microorganism was identified in 48 patients (52%), the two most frequent etiologies being Streptococcus pneumoniae (14, 15%) and Legionella pneumophila (13, 14%). Pseudomonas aeruginosa (5, 5%) was always associated with bronchiectasis. Mortality due to severe community-acquired pneumonia was 22% (20 patients). According to univariate analysis, mortality was associated with anticipated death within 4 to 5 yr, inadequate antibiotic treatment before RICU admission, mechanical ventilation requirements, use of PEEP, FIO2 greater than 0.6, coexistence of ARDS, radiographic spread of the pneumonia during RICU admission, septic shock, bacteremia, and P. aeruginosa as the cause of the pneumonia. Further, recursive partitioning analysis selected two factors significantly related to the prognosis: the radiographic spread of the pneumonia during RICU admission and the presence of septic shock.(ABSTRACT TRUNCATED AT 250 WORDS)

Detection of Legionella pneumophila serogroup 1 in blood cultures from a patient treated with tumor necrosis factor-alpha inhibitor

“…The reported incidence of LD in CAP ranges from 1.6% to 7.5% [2][3][4][5][6] and that in severe CAP is between 14% and 22.8%) [6][7][8]. Legionnaires' disease has appeared in hospitals, long-term care facilities and other types of accommodation [9][10][11][12][13][14][15], causing serious problems.…”

Role of initial arterial blood gas variations in predicting the outcome of pneumonia patients with type I/II respiratory failure

“…36.36% of the patients were either hypertensive or diabetic and 9% were both hypertensive and diabetic. Many articles have shown a link between chronic obstructive pulmonary disease and community-acquired pneumonia in that episodes of AECOPD could be associated with an episode of CAP [13][14][15][16][17][18] , and also CAP as a complication of the long term use of potent inhalational steroids used for the control of COPD. 22,23 COPD is considered as a risk factor for CAP, and previous studies of CAP including inpatient, outpatient, and ICU cohorts have shown that COPD is frequently reported as a co-morbid condition.…”

Respiratory infections: Proceedings of the Eighth Liverpool Tropical School Bayer Symposium of Microbial Disease held on 3 February 2001

“…Woodhead et al [65] have shown that administration of antibiotics by general practitioners before admission reduces subsequent inhospital mortality. Similarly, delay or inadequate antibiotic therapy after admission to hospital [66] or before admission to the intensive care unit (ICU) [67] is associated with increased mortality in patients admitted to hospital and ICU respectively.…”