Jonathan Messika1, Annabelle Stoclin2, Eric Bouvard3, Jean-Pierre Fulgencio2, Christophe Ridel4, Ioan-Paul Muresan5, Jean-Jacques Boffa6, Claude Bachmeyer3, Michel Denis7, Valérie Gounant8, Adoracion Esteso9, Valeria Loi10, Charlotte Verdet11, Hélène Prigent12, Antoine Parrot2, Muriel Fartoukh13. 1. Service de Réanimation Médico-Chirurgicale, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France, Service de Réanimation Médico-Chirurgicale, Hôpital Louis Mourier, AP-HP, Colombes, France, Univ Paris Diderot, Sorbonne Paris Cité, IAME, UMRS 1137, Paris, France, and INSERM, IAME, U1137, Paris, France. 2. Service de Réanimation Médico-Chirurgicale, Hôpital Tenon, AP-HP, Paris, France. 3. Service de Médecine Interne, Hôpital Tenon, AP-HP, Paris, France. 4. Service des Urgences Néphrologiques et Transplantation Rénale, Hôpital Tenon, AP-HP, Paris, France. 5. Service de Neurologie, Hôpital Tenon, AP-HP, Paris, France. 6. Service de Néphrologie et Dialyse, Hôpital Tenon, AP-HP, Paris, France and Sorbonne Universités, UPMC Univ Paris 06, Paris, France. 7. Service de Maladies Infectieuses et Tropicales, Hôpital Tenon, AP-HP, Paris, France. 8. Service de Pneumologie, Hôpital Tenon, AP-HP, Paris, France. 9. Service d'Oncologie Médicale, Hôpital Tenon, AP-HP, Paris, France. 10. Service de Chirurgie Digestive, AP-HP, Hôpital Tenon, Paris, France. 11. Laboratoire de Bactériologie, Hôpital Tenon, AP-HP, Paris, France. 12. Service de Réanimation Médico-Chirurgicale, Hôpital Tenon, AP-HP, and Sorbonne Universités, UPMC Univ Paris 06, Paris, France. 13. Service de Réanimation Médico-Chirurgicale, Hôpital Tenon, AP-HP, and Sorbonne Universités, UPMC Univ Paris 06, Paris, France. muriel.fartoukh@tnn.aphp.fr.
Abstract
BACKGROUND: Early recognition and an attempt at obtaining microbiological documentation are recommended in patients with non-community-acquired pneumonia (NCAP), whether hospital-acquired (HAP) or health care-associated (HCAP). We aimed to characterize the clinical features and microbial etiologies of NCAP to assess the impact of microbiological investigation on their management. METHODS: This was a prospective 1-y study in a university hospital with 141 non-mechanically ventilated subjects suspected of having HAP (n = 110) or HCAP (n = 31). RESULTS: Clinical criteria alone poorly identified pneumonia (misdiagnosis in 50% of cases). Microbiological confirmation was achievable in 80 subjects (57%). Among 79 microorganisms isolated, 28 were multidrug-resistant aerobic Gram-negative bacilli and group III Enterobacteriaceae and 6 were methicillin-resistant Staphylococcus aureus. Multidrug-resistant aerobic Gram-negative bacilli accounted for one third of the microorganisms in early-onset HAP and for 50% in late-onset HAP. Methicillin-resistant S. aureus was most often recovered from subjects with HCAP. Inappropriate empirical antibiotics were administered to 36% of subjects with confirmed pneumonia. Forty subjects were admitted to the ICU, 13 (33%) of whom died. Overall, 39 subjects (28%) died in the hospital. CONCLUSIONS: Integrating the microbiological investigation in the complex clinical diagnostic workup of patients suspected of having NCAP is mandatory. Respiratory tract specimens should be obtained whenever possible for appropriate management.
BACKGROUND: Early recognition and an attempt at obtaining microbiological documentation are recommended in patients with non-community-acquired pneumonia (NCAP), whether hospital-acquired (HAP) or health care-associated (HCAP). We aimed to characterize the clinical features and microbial etiologies of NCAP to assess the impact of microbiological investigation on their management. METHODS: This was a prospective 1-y study in a university hospital with 141 non-mechanically ventilated subjects suspected of having HAP (n = 110) or HCAP (n = 31). RESULTS: Clinical criteria alone poorly identified pneumonia (misdiagnosis in 50% of cases). Microbiological confirmation was achievable in 80 subjects (57%). Among 79 microorganisms isolated, 28 were multidrug-resistant aerobic Gram-negative bacilli and group III Enterobacteriaceae and 6 were methicillin-resistant Staphylococcus aureus. Multidrug-resistant aerobic Gram-negative bacilli accounted for one third of the microorganisms in early-onset HAP and for 50% in late-onset HAP. Methicillin-resistant S. aureus was most often recovered from subjects with HCAP. Inappropriate empirical antibiotics were administered to 36% of subjects with confirmed pneumonia. Forty subjects were admitted to the ICU, 13 (33%) of whom died. Overall, 39 subjects (28%) died in the hospital. CONCLUSIONS: Integrating the microbiological investigation in the complex clinical diagnostic workup of patients suspected of having NCAP is mandatory. Respiratory tract specimens should be obtained whenever possible for appropriate management.