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A five-year study of severe community-acquired pneumonia with emphasis on prognosis in patients admitted to an intensive care unit

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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

  1. 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

    Article  PubMed  CAS  Google Scholar 

  2. 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

    Article  PubMed  CAS  Google Scholar 

  3. Van Eeden SF, Coetzee AR, Joubert JR (1988) Community-acquired pneumonia — factors influencing intensive care admission. S Afr Med J 73:77–81

    PubMed  Google Scholar 

  4. 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

    PubMed  CAS  Google Scholar 

  5. 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

    PubMed  CAS  Google Scholar 

  6. 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

    PubMed  CAS  Google Scholar 

  7. 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

    Google Scholar 

  8. McCabe WR, Jackson CG (1962) Gram-negative bacteremia: etiology and ecology. Arch Intern Med 110:847–855

    Google Scholar 

  9. Le Gall JR, Loirat P, Alperovitch A (1983) Simplified acute physiologic score for intensive care patient. Lancet II:741

    Article  Google Scholar 

  10. Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) Prognosis in acute organ system failure. Ann Surg 6:685

    Google Scholar 

  11. 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

    Article  PubMed  CAS  Google Scholar 

  12. Teasdale G, Jennet B (1974) Assessment of coma and impaired consciousness. Lancet II:81

    Article  Google Scholar 

  13. 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

    PubMed  CAS  Google Scholar 

  14. 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

    Google Scholar 

  15. 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

    Google Scholar 

  16. Marrie TJ, Durant H, Yates L (1989) Community-acquired pneumonia requiring hospitalization: 5-year prospective study. Rev Infect Dis 11:586–599

    PubMed  CAS  Google Scholar 

  17. Richard V, Lepoutre A (1993) Les cas de legionellose déclarés en France en 1991 et 1992. BEH 30:133–134

    Google Scholar 

  18. Farr BM, Sloman AJ, Fisch MJ (1991) Predicting death in patients hospitalized for community-acquired pneumonia. Ann Intern Med 115:428–436

    PubMed  CAS  Google Scholar 

  19. McNabb WR, Shanson DC, Williams TDM, Lant AF (1984) Adult community-acquired pneumonia in central London. J R Soc Med 77:550–555

    PubMed  CAS  Google Scholar 

  20. 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

    PubMed  CAS  Google Scholar 

  21. 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

    Article  PubMed  CAS  Google Scholar 

  22. Hickling KG, Howard R (1988) A retrospective survey of treatment and mortality in aspiration pneumonia. Intensive Care Med 14:617–622

    Article  PubMed  CAS  Google Scholar 

  23. Leroy O, Beuscart C, Mouton, Y (1988) Gram-negative nosocomial infection: incidence, pathogens, compromised host. Br J Clin Pract 42:27–35

    Google Scholar 

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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

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