Epidemiology and outcome of severe pneumococcal pneumonia admitted to intensive care unit: a multicenter study
Critical Care, 08/16/2012
Mongardon N et al. – In ICU, mortality of pneumococcal Community–acquired pneumonia (CAP) remains high despite adequate antimicrobial treatment. Baseline demographic data and renal replacement therapy have a major impact on adverse outcome.Methods
- The authors performed a retrospective review of two prospectively–acquired multicentre ICU databases (2001–2008).
- Patients admitted for management of severe pneumococcal CAP were enrolled if they met the 2001 American Thoracic Society criteria for severe pneumonia, had life–threatening organ failure and had a positive microbiological sample for S. pneumoniae.
- Patients with bronchitis, aspiration pneumonia or with non–pulmonary pneumococcal infections were excluded.
- Two hundred and twenty two patients were included, with a median SAPS 2 score reaching 47 [36–64].
- Acute respiratory failure (n=154) and septic shock (n=54) were their most frequent causes of ICU admission.
- Septic shock occurred in 170 patients (77%) and mechanical ventilation was required in 186 patients (84%); renal replacement therapy was initiated in 70 patients (32%).
- Bacteremia was diagnosed in 101 patients.
- The prevalence of S. pneumoniae strains with decreased susceptibility to penicillin was 39.7%.
- Although antibiotherapy was adequate in 92.3% of cases, hospital mortality reached 28.8%.
- In multivariate analysis, independent risk factors for mortality were age [OR 1.05 (95% CI: 1.02–1.08)], male sex [OR 2.83 (95% CI: 1.16–6.91)] and renal replacement therapy [OR 3.78 (95% CI: 1.71–8.36)].
- Co–morbidities, macrolide administration, concomitant bacteremia or penicillin susceptibility did not influence outcome.