Chest
Original ResearchChest InfectionsFeaturedDecrease in Mortality in Severe Community-Acquired Pneumococcal Pneumonia: Impact of Improving Antibiotic Strategies (2000-2013)
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Materials and Methods
This was a matched case-control study of two cohorts of patients prospectively recorded in Europe (the Community-Acquired Pneumonia en la Unidad de Cuidados Intensivos [CAPUCI] studies). CAPUCI I and II are two European, prospective, multicenter studies conducted in patients admitted to the ICU for CAP. The CAPUCI I study recorded data from 33 hospitals from 2000 to 2002. Data from this cohort have been reported elsewhere.11 The CAPUCI II study was a follow-up project endorsed by the European
Results
One hundred and sixty patients were enrolled: 80 patients from the 2008 to 2013 cohort (case group) paired with 80 from the 2000 to 2002 cohort (control group). Figure 1 shows the algorithm for the selection of the patients and the ICU mortality for each subgroup; incidence of severe pneumococcal pneumonia increased significantly (43.9% vs 27.0%; OR, 1.30; 95% CI, 1.15-1.48). Table 1 shows the variables used to match patients. The groups presented identical prevalence of the items evaluated:
Discussion
The main finding of this study was a 15% decrease in ICU mortality due to SCAP caused by S pneumoniae during the study period. Several changes in antibiotic prescription practices were detected, and an association between improved survival and both earlier antibiotic administration and increased combined antibiotic therapy was identified.
The World Health Organization's annual reports stress the minimal decrease in worldwide mortality secondary to lower respiratory infection: from 4.1 million
Conclusions
In summary, incidence, mortality, and management of severe pneumococcal pneumonia has significantly changed in the last decade. Improved ICU survival was associated with earlier antibiotic prescription and increased use of combined antibiotic therapy.
Acknowledgments
Author contributions: S. G. served as principal author, had full access to all of the data in the study, and takes responsibility for the integrity of the data and the accuracy of the data analysis. S. G. and J. R. contributed to the study concept and design; B. B., J. S.-V., J. V., L. V., R. Z., and A. T. contributed to data interpretation; S. G. and J. R. contributed to drafting of the manuscript; B. B., J. S.-V., J. V., L. V., R. Z., and A. T. contributed to critical revision of the
References (51)
- et al.
Risk factors and pathogenic significance of bacteremic pneumonia in adult patients with community-acquired pneumococcal pneumonia
J Infect
(2013) - et al.
Cytokine activation patterns and biomarkers are influenced by microorganisms in community-acquired pneumonia
Chest
(2012) - et al.
Systemic inflammatory pattern of patients with community-acquired pneumonia with and without COPD
Chest
(2013) Community-acquired pneumonia in adults in mainland Portugal: incidence and mortality in hospital inpatients between 1998 and 2000 [in Portugese]
Rev Port Pneumol
(2003)- et al.
Nationwide trends of severe sepsis in the 21st century (2000-2007)
Chest
(2011) - et al.
A three-year study of severe community-acquired pneumonia with emphasis on outcome
Chest
(1993) - et al.
Predictive factors of mortality in severe community-acquired pneumonia: a model with data on the first 24h of ICU admission
Med Intensiva
(2013) New intervention strategies for reducing antibiotic resistance
Chest
(1999)- et al.
The impact of guidelines on the outcomes of community-acquired and ventilator-associated pneumonia
Clin Chest Med
(2011) - et al.
Delayed administration of antibiotics and atypical presentation in community-acquired pneumonia
Chest
(2006)
Early administration of the first antimicrobials should be considered a marker of optimal care of patients with community-acquired pneumonia rather than a predictor of outcomes
Int J Infect Dis
Severity of pneumococcal pneumonia associated with genomic bacterial load
Chest
Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults
Clin Infect Dis
Clinical and economic burden of community-acquired pneumonia among adults in Europe
Thorax
Severe community-acquired pneumonia: use of intensive care services and evaluation of American and British Thoracic Society Diagnostic criteria
Am J Respir Crit Care Med
Hospitalized community-acquired pneumonia in the elderly: age- and sex-related patterns of care and outcome in the United States
Am J Respir Crit Care Med
The impact of prior outpatient ACE inhibitor use on 30-day mortality for patients hospitalized with community-acquired pneumonia
BMC Pulm Med
Comparison between pathogen directed antibiotic treatment and empirical broad spectrum antibiotic treatment in patients with community acquired pneumonia: a prospective randomised study
Thorax
Empirical atypical coverage for inpatients with community-acquired pneumonia: systematic review of randomized controlled trials
Arch Intern Med
Antibiotic prescription for community-acquired pneumonia in the intensive care unit: impact of adherence to Infectious Diseases Society of America guidelines on survival
Clin Infect Dis
Update of practice guidelines for the management of community-acquired pneumonia in immunocompetent adults
Clin Infect Dis
Prognosis and outcomes of patients with community-acquired pneumonia. A meta-analysis
JAMA
Microbial etiology of community-acquired pneumonia in the adult population of 4 municipalities in eastern Finland
Clin Infect Dis
Incidence of community-acquired pneumonia in the population of four municipalities in eastern Finland
Am J Epidemiol
Increasing hospital admissions for pneumonia, England
Emerg Infect Dis
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*The investigators in the Community-Acquired Pneumonia en la Unidad de Cuidados Intensivos (CAPUCI) II study group are listed in e-Appendix 1.
FUNDING/SUPPORT: This study received support from the following: 2001/SGR414, Red Respira Instituto de Salud Carlos III [RTIC 03/11], fondo de investigación sanitaria [PI 04/1500], and Centro de Investigación en Red de Enfermedades Respiratorias (proyecto corporativo de investigación Pneumonia).
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