OBJECTIVES: The impact of ICU-acquired pneumonia without etiologic diagnosis on patients' outcomes is largely unknown. We compared the clinical characteristics, inflammatory response, and outcomes between patients with and without microbiologically confirmed ICU-acquired pneumonia. DESIGN: Prospective observational study. SETTING: ICUs of a university teaching hospital. PATIENTS: We prospectively collected 270 consecutive patients with ICU-acquired pneumonia. Patients were clustered according to positive or negative microbiologic results. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We compared the characteristics and outcomes between both groups. Negative microbiology was found in 82 patients (30%). Both groups had similar baseline severity scores. Patients with negative microbiology presented more frequently chronic renal failure (15 [18%] vs 11 [6%]; p=0.003), chronic heart disorders (35 [43%] vs 55 [29%]; p=0.044), less frequently previous intubation (44 [54%] vs 135 [72%]; p=0.006), more severe hypoxemia (PaO2/FIO2: 165±73 mm Hg vs 199±79 mm Hg; p=0.001), and shorter ICU stay before the onset of pneumonia (5±5 days vs 7±9 days; p=0.001) compared with patients with positive microbiology. The systemic inflammatory response was similar between both groups. Negative microbiology resulted in less changes of empiric treatment (33 [40%] vs 112 [60%]; p=0.005) and shorter total duration of antimicrobials (13±6 days vs 17±12 days; p=0.006) than positive microbiology. Following adjustment for potential confounders, patients with positive microbiology had higher hospital mortality (adjusted odds ratio 2.96, 95% confidence interval 1.24-7.04, p=0.014) and lower 90-day survival (adjusted hazard ratio 0.50, 95% confidence interval 0.27-0.94, p=0.031), with a nonsignificant lower 28-day survival. CONCLUSIONS: Although the possible influence of previous intubation in mortality of both groups is not completely discarded, negative microbiologic findings in clinically suspected ICU-acquired pneumonia are associated with less frequent previous intubation, shorter duration of antimicrobial treatment, and better survival. Future studies should corroborate the presence of pneumonia in patients with suspected ICU-acquired pneumonia and negative microbiology.
OBJECTIVES: The impact of ICU-acquired pneumonia without etiologic diagnosis on patients' outcomes is largely unknown. We compared the clinical characteristics, inflammatory response, and outcomes between patients with and without microbiologically confirmed ICU-acquired pneumonia. DESIGN: Prospective observational study. SETTING: ICUs of a university teaching hospital. PATIENTS: We prospectively collected 270 consecutive patients with ICU-acquired pneumonia. Patients were clustered according to positive or negative microbiologic results. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We compared the characteristics and outcomes between both groups. Negative microbiology was found in 82 patients (30%). Both groups had similar baseline severity scores. Patients with negative microbiology presented more frequently chronic renal failure (15 [18%] vs 11 [6%]; p=0.003), chronic heart disorders (35 [43%] vs 55 [29%]; p=0.044), less frequently previous intubation (44 [54%] vs 135 [72%]; p=0.006), more severe hypoxemia (PaO2/FIO2: 165±73 mm Hg vs 199±79 mm Hg; p=0.001), and shorter ICU stay before the onset of pneumonia (5±5 days vs 7±9 days; p=0.001) compared with patients with positive microbiology. The systemic inflammatory response was similar between both groups. Negative microbiology resulted in less changes of empiric treatment (33 [40%] vs 112 [60%]; p=0.005) and shorter total duration of antimicrobials (13±6 days vs 17±12 days; p=0.006) than positive microbiology. Following adjustment for potential confounders, patients with positive microbiology had higher hospital mortality (adjusted odds ratio 2.96, 95% confidence interval 1.24-7.04, p=0.014) and lower 90-day survival (adjusted hazard ratio 0.50, 95% confidence interval 0.27-0.94, p=0.031), with a nonsignificant lower 28-day survival. CONCLUSIONS: Although the possible influence of previous intubation in mortality of both groups is not completely discarded, negative microbiologic findings in clinically suspected ICU-acquired pneumonia are associated with less frequent previous intubation, shorter duration of antimicrobial treatment, and better survival. Future studies should corroborate the presence of pneumonia in patients with suspected ICU-acquired pneumonia and negative microbiology.
Authors: Andre C Kalil; Mark L Metersky; Michael Klompas; John Muscedere; Daniel A Sweeney; Lucy B Palmer; Lena M Napolitano; Naomi P O'Grady; John G Bartlett; Jordi Carratalà; Ali A El Solh; Santiago Ewig; Paul D Fey; Thomas M File; Marcos I Restrepo; Jason A Roberts; Grant W Waterer; Peggy Cruse; Shandra L Knight; Jan L Brozek Journal: Clin Infect Dis Date: 2016-07-14 Impact factor: 9.079
Authors: Gennaro De Pascale; Otavio T Ranzani; Saad Nseir; Jean Chastre; Tobias Welte; Massimo Antonelli; Paolo Navalesi; Eugenio Garofalo; Andrea Bruni; Luis Miguel Coelho; Szymon Skoczynski; Federico Longhini; Fabio Silvio Taccone; David Grimaldi; Helmut J F Salzer; Christoph Lange; Filipe Froes; Antoni Artigas; Emili Díaz; Jordi Vallés; Alejandro Rodríguez; Mauro Panigada; Vittoria Comellini; Luca Fasano; Paolo M Soave; Giorgia Spinazzola; Charles-Edouard Luyt; Francisco Alvarez-Lerma; Judith Marin; Joan Ramon Masclans; Davide Chiumello; Angelo Pezzi; Marcus Schultz; Hafiz Mohamed; Menno Van Der Eerden; Roger A S Hoek; D A M P J Gommers; Marta Di Pasquale; Rok Civljak; Marko Kutleša; Matteo Bassetti; George Dimopoulos; Stefano Nava; Fernando Rios; Fernando G Zampieri; Pedro Povoa; Lieuwe D Bos; Stefano Aliberti; Antoni Torres; Ignacio Martín-Loeches Journal: ERJ Open Res Date: 2017-11-17
Authors: Otavio Tavares Ranzani; Daniel Neves Forte; Antonio Carlos Forte; Igor Mimica; Wilma Carvalho Neves Forte Journal: J Bras Pneumol Date: 2016 May-Jun Impact factor: 2.624