Abstract
Objectives
To characterize the epidemiology and to determine the prognosis factors in severe community-acquired pneumonia among patients admitted to an intensive care unit.
Design
Retrospective clinical study.
Setting
Intensive Care and Infectious Diseases Unit of a municipal general hospital of Lille University Medical School.
Patients
299 consecutive patients exhibiting severe community-acquired pneumonia.
Measurements and results
On admission to ICU, 149 patients required mechanical ventilation for acute respiratory failure and 44 exhibited septic shock. Pulmonary involvement was bilateral in 71 patients. There were 260 organisms isolated from 197 patients (65.9%), the most frequent beingStreptococcus pneumoniae (n=80),Staphylococcus spp. (n=57) and Gram-negative bacilli (n=81). Overall mortality was 28.5% (85 patients). According to univariate analysis, mortality was associated with age over 60 years, anticipated death within 5 years, immunosuppression, shock, mechanical ventilation, bilateral pulmonary involvement, bacteremia, neutrophil count <3500/mm3, total serum protein level <45 g/l, serum creatinine >15 mg/l, non-aspiration pneumonia, ineffective initial therapy and complications. Multivariate analysis selected only 5 factors significantly associated with prognosis: anticipated death within 5 years, shock, bacteremia, non-pneumonia-related complications and ineffective initial therapy.
Conclusion
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.
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References
Fine MJ, Smith DN, Singer DE (1990) Hospitalization decision in patients with community-acquired pneumonia: a prospective cohort study. Am J Med 89:713–721
Fine MJ, Singer DE, Hanusa BH, Lave JR, Kapoor WN (1993) Validation of a pneumonia prognostic index using the medisgroups comparative hospital database. Am J Med 94:153–159
Van Eeden SF, Coetzee AR, Joubert JR (1988) Community-acquired pneumonia — factors influencing intensive care admission. S Afr Med J 73:77–81
Fang GD, Fine M, Orloff J, Arisumi D, Yu VL, Kapoor W, Grayston T, Wang SP, Kohler R, Muder RR, Yee YC, Riks JD, Vickers RM (1990) New and emerging etiologies for community-acquired pneumonia with implications for therapy. A prospective multicenter study of 359 cases. Medicine 69:307–316
Torres A, Serra-Batlles J, Ferrer A, Jiminez P, Celis R, Cobo E, Rodriguez-Roisin R (1991) Severe community-acquired pneumonia. Epidemiology and prognostic factors. Am Rev Respir Dis 144:312–318
Fine MJ, Orloff JJ, Arisumi D, Fang G, Arena VC, Hanusa BH, Yu VL, Singer DE, Kapoor WN (1990) Prognosis of patients hospitalized with community-acquired pneumonia. Am J Med 88 [Suppl 5]:1N-8N
Thompson RL (1987) Surveillance and reporting of nosocomial infections. In: Wenzel RP (ed) Prevention and control of nosocomial infections. Williams and Wilkins, Baltimore, pp 70–82
McCabe WR, Jackson CG (1962) Gram-negative bacteremia: etiology and ecology. Arch Intern Med 110:847–855
Le Gall JR, Loirat P, Alperovitch A (1983) Simplified acute physiologic score for intensive care patient. Lancet II:741
Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) Prognosis in acute organ system failure. Ann Surg 6:685
Bone RC, Fisher CJ, Clemmer TP, Slotman GJ, Metz CA, Balk RA (1989) The methylprednisolone severe sepsis study group. Sepsis syndrome: a valid clinical entity. Crit Care Med 17:389–393
Teasdale G, Jennet B (1974) Assessment of coma and impaired consciousness. Lancet II:81
Pachon J, Prados MD, Capote F, Cuello JA, Garnacho J, Verano A (1990) Severe community-acquired pneumonia. Etiology, prognosis, and treatment. Am Rev Respir Dis 142: 369–373
Levy M, Dromer F, Brion N, Leturdu F, Carbon C (1988) Community-acquired pneumonia. Importance of initial noninvasive bacteriologic and radiographic investigations. Chest 92:43–48
Research Committee of the British Thoracic Society and the Public Health Laboratory Service (1987) Community-acquired pneumonia in adults in British hospitals in 1982–1983: a survey of aetiology, mortality, prognosis factors and outcome. Q J Med 62:195–220
Marrie TJ, Durant H, Yates L (1989) Community-acquired pneumonia requiring hospitalization: 5-year prospective study. Rev Infect Dis 11:586–599
Richard V, Lepoutre A (1993) Les cas de legionellose déclarés en France en 1991 et 1992. BEH 30:133–134
Farr BM, Sloman AJ, Fisch MJ (1991) Predicting death in patients hospitalized for community-acquired pneumonia. Ann Intern Med 115:428–436
McNabb WR, Shanson DC, Williams TDM, Lant AF (1984) Adult community-acquired pneumonia in central London. J R Soc Med 77:550–555
Ortqvist A, Sterner G, Nilsson JA (1985) Severe community-acquired pneumonia: factors influencing need in intensive care treatment and prognosis. Scand J Infect Dis 17:377–386
Feldman C, Kallenbach JM, Levy H, Reinach SG, Hurwitz MD, Thorburn JR, Koornhof HJ (1989) Community-acquired pneumonia of diverse aetiology: prognostic features in patients admitted to an intensive care unit and a “severity of illness” score. Intensive Care Med 15:302–307
Hickling KG, Howard R (1988) A retrospective survey of treatment and mortality in aspiration pneumonia. Intensive Care Med 14:617–622
Leroy O, Beuscart C, Mouton, Y (1988) Gram-negative nosocomial infection: incidence, pathogens, compromised host. Br J Clin Pract 42:27–35
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Leroy, O., Santré, C., Beuscart, C. et al. A five-year study of severe community-acquired pneumonia with emphasis on prognosis in patients admitted to an intensive care unit. Intensive Care Med 21, 24–31 (1995). https://doi.org/10.1007/BF02425150
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DOI: https://doi.org/10.1007/BF02425150