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Mortality in ICU patients with bacterial community-acquired pneumonia: when antibiotics are not enough

Alejandro Rodriguez, Thiago Lisboa, Stijn Blot UGent, Ignacio Martin-Loeches, Jorge Sole-Violan, Diego De Mendoza and Jordi Rello (2009) INTENSIVE CARE MEDICINE. 35(3). p.430-438
abstract
It remains uncertain why immunocompetent patients with bacterial community-acquired pneumonia (CAP) die, in spite of adequate antibiotics. This is a secondary analysis of the CAPUCI database which was a prospective observational multicentre study. Two hundred and twelve immunocompetent patients admitted to 33 Spanish ICUs for CAP were analyzed. Comparisons were made for lifestyle risk factors, comorbidities and severity of illness. ICU mortality was the principal outcome variable. Bacteremic CAP (43.3 vs. 21.1%) and empyema (11.5 vs. 2.2%) were more frequent (P < 0.05) in patients with Streptococcus pneumoniae CAP. Higher rates of adequate empiric therapy (95.8 vs. 75.5%, P < 0.05) were observed in patients with S. pneumoniae CAP. Patients with non-pneumococcal CAP experienced more shock (66.7 vs. 50.8%, P < 0.05), and need for mechanical ventilation (83.3 vs. 61.5%, P < 0.05). ICU mortality was 20.7 and 28% [OR 1.49(0.74-2.98)] among immunocompetent patients with S. pneumoniae (n = 122) and non-pneumococci (n = 90), in spite of initial adequate antibiotic. Multivariable regression analysis in these 184 immunocompetent patients with adequate empirical antibiotic treatment identified the following variables as independently associated with mortality: shock (HR 13.03); acute renal failure (HR 4.79), and APACHE II score higher than 24 (HR 2.22). Mortality remains unacceptably high in immunocompetent patients admitted to the ICU with bacterial pneumonia, despite adequate initial antibiotics and comorbidities management. Patients with shock, acute renal failure and APACHE II score higher than 24 should be considered for inclusion in trials of adjunctive therapy in order to improve CAP survival.
Please use this url to cite or link to this publication:
author
organization
year
type
journalArticle (original)
publication status
published
subject
keyword
Community-acquired pneumonia, Pneumococccal pneumonia, Adjuvant therapy, INTENSIVE-CARE-UNIT, SEVERE SEPSIS, THERAPY, SURVIVAL, EPIDEMIOLOGY, CRITERIA, OUTCOMES, CAP
journal title
INTENSIVE CARE MEDICINE
Intensive Care Med.
volume
35
issue
3
pages
430 - 438
Web of Science type
Article
Web of Science id
000263421400006
JCR category
CRITICAL CARE MEDICINE
JCR impact factor
5.168 (2009)
JCR rank
3/22 (2009)
JCR quartile
1 (2009)
ISSN
0342-4642
DOI
10.1007/s00134-008-1363-6
language
English
UGent publication?
yes
classification
A1
copyright statement
I have transferred the copyright for this publication to the publisher
id
1987131
handle
http://hdl.handle.net/1854/LU-1987131
date created
2012-01-16 13:32:23
date last changed
2016-12-19 15:42:53
@article{1987131,
  abstract     = {It remains uncertain why immunocompetent patients with bacterial community-acquired pneumonia (CAP) die, in spite of adequate antibiotics. 
This is a secondary analysis of the CAPUCI database which was a prospective observational multicentre study. Two hundred and twelve immunocompetent patients admitted to 33 Spanish ICUs for CAP were analyzed. Comparisons were made for lifestyle risk factors, comorbidities and severity of illness. ICU mortality was the principal outcome variable. 
Bacteremic CAP (43.3 vs. 21.1\%) and empyema (11.5 vs. 2.2\%) were more frequent (P {\textlangle} 0.05) in patients with Streptococcus pneumoniae CAP. Higher rates of adequate empiric therapy (95.8 vs. 75.5\%, P {\textlangle} 0.05) were observed in patients with S. pneumoniae CAP. Patients with non-pneumococcal CAP experienced more shock (66.7 vs. 50.8\%, P {\textlangle} 0.05), and need for mechanical ventilation (83.3 vs. 61.5\%, P {\textlangle} 0.05). ICU mortality was 20.7 and 28\% [OR 1.49(0.74-2.98)] among immunocompetent patients with S. pneumoniae (n = 122) and non-pneumococci (n = 90), in spite of initial adequate antibiotic. Multivariable regression analysis in these 184 immunocompetent patients with adequate empirical antibiotic treatment identified the following variables as independently associated with mortality: shock (HR 13.03); acute renal failure (HR 4.79), and APACHE II score higher than 24 (HR 2.22). 
Mortality remains unacceptably high in immunocompetent patients admitted to the ICU with bacterial pneumonia, despite adequate initial antibiotics and comorbidities management. Patients with shock, acute renal failure and APACHE II score higher than 24 should be considered for inclusion in trials of adjunctive therapy in order to improve CAP survival.},
  author       = {Rodriguez, Alejandro and Lisboa, Thiago and Blot, Stijn and Martin-Loeches, Ignacio and Sole-Violan, Jorge and De Mendoza, Diego and Rello, Jordi},
  issn         = {0342-4642},
  journal      = {INTENSIVE CARE MEDICINE},
  keyword      = {Community-acquired pneumonia,Pneumococccal pneumonia,Adjuvant therapy,INTENSIVE-CARE-UNIT,SEVERE SEPSIS,THERAPY,SURVIVAL,EPIDEMIOLOGY,CRITERIA,OUTCOMES,CAP},
  language     = {eng},
  number       = {3},
  pages        = {430--438},
  title        = {Mortality in ICU patients with bacterial community-acquired pneumonia: when antibiotics are not enough},
  url          = {http://dx.doi.org/10.1007/s00134-008-1363-6},
  volume       = {35},
  year         = {2009},
}

Chicago
Rodriguez, Alejandro, Thiago Lisboa, Stijn Blot, Ignacio Martin-Loeches, Jorge Sole-Violan, Diego De Mendoza, and Jordi Rello. 2009. “Mortality in ICU Patients with Bacterial Community-acquired Pneumonia: When Antibiotics Are Not Enough.” Intensive Care Medicine 35 (3): 430–438.
APA
Rodriguez, Alejandro, Lisboa, T., Blot, S., Martin-Loeches, I., Sole-Violan, J., De Mendoza, D., & Rello, J. (2009). Mortality in ICU patients with bacterial community-acquired pneumonia: when antibiotics are not enough. INTENSIVE CARE MEDICINE, 35(3), 430–438.
Vancouver
1.
Rodriguez A, Lisboa T, Blot S, Martin-Loeches I, Sole-Violan J, De Mendoza D, et al. Mortality in ICU patients with bacterial community-acquired pneumonia: when antibiotics are not enough. INTENSIVE CARE MEDICINE. 2009;35(3):430–8.
MLA
Rodriguez, Alejandro, Thiago Lisboa, Stijn Blot, et al. “Mortality in ICU Patients with Bacterial Community-acquired Pneumonia: When Antibiotics Are Not Enough.” INTENSIVE CARE MEDICINE 35.3 (2009): 430–438. Print.