Maité Garrouste-Orgeas1,2,3, Elie Azoulay4, Stéphane Ruckly5, Carole Schwebel6, Etienne de Montmollin7, Jean-Pierre Bedos8, Bertrand Souweine9, Guillaume Marcotte10, Christophe Adrie11, Dany Goldgran-Toledano12, Anne-Sylvie Dumenil13, Hatem Kallel14, Samir Jamali15, Laurent Argaud16, Michael Darmon17,18, Jean-Ralph Zahar19, J F Timsit20,5,21. 1. UMR 1137, IAME Team 5, DeSCID: Decision Sciences in Infectious Diseases, Control and Care, Sorbonne Paris Cité, Inserm/Paris Diderot University, Paris, France. Maite.garrouste@ihfb.org. 2. Medical Unit, French and British Institute, Levallois-Perret, France. Maite.garrouste@ihfb.org. 3. Outcomerea Research Group, Paris, France. Maite.garrouste@ihfb.org. 4. Medical Intensive Care Unit, Saint Louis University Hospital, Paris, France. 5. Outcomerea Research Group, Paris, France. 6. Medical Intensive Care Unit, Albert Michallon Hospital, Grenoble, France. 7. Medical-Surgical Intensive Care Unit, Delafontaine Hospital, Saint-Denis, France. 8. Medical Intensive Care Unit, André Mignot Hospital, Le Chesnay, France. 9. Medical Intensive Care Unit, Gabriel Montpied University Hospital, Clermont-Ferrand, France. 10. Surgical ICU, Edouard Herriot University Hospital, Lyon, France. 11. Physiology department, Cochin University Hospital, Paris Descartes University, Paris, France. 12. Medical-Surgical Intensive Care Unit, Montfermeil, France. 13. Medical Intensive Care Unit, Antoine Béclère Hospital, Clamart, France. 14. Medical-Surgical Unit, Andrée Rosemon Hospital, Cayenne, Guyane, France. 15. Medical-Surgical Unit, Sud-Essonne Hospital, Dourdan, France. 16. Medical Intensive Care Unit, Edouard Herriot University Hospital, Lyon, France. 17. Medical Intensive Care Unit, Saint Etienne University Hospital, Saint-Étienne, France. 18. Jacques Lisfranc Medicine University, Jean Monnet University, Saint-Étienne, France. 19. Infection Control Unit, Avicenne University Hospital, Bobigny, France. 20. UMR 1137, IAME Team 5, DeSCID: Decision Sciences in Infectious Diseases, Control and Care, Sorbonne Paris Cité, Inserm/Paris Diderot University, Paris, France. 21. Medical and Infectious Diseases Intensive Care Unit, Bichat University Hospital, Paris Diderot University, Paris, France.
Abstract
PURPOSES: Streptococcus pneumoniae is a leading pathogen of severe community, hospital or nursing facility infections. We sought to describe characteristics of invasive pneumococcal infection (IPI) and pneumonia (due to the high mortality of intensive care-associated pneumonia) and to report outcomes according to various types of comorbidity. METHODS: Multicenter observational cohort study on the prospective Outcomerea database, including adult patients, with a hospital stay < 48 h before ICU admission and a documented IPI within the first 72 h of ICU admission. Comorbid conditions were defined according to the Knaus and Charlson classification. RESULTS: Of the 20,235 patients, 5310 (26.4%) had an invasive infection, including 560/5,310 (10.6%) who had an IPI. The ICU 28-day mortality was 109/560 (19.8%). Four factors were independently associated with mortality: SOFA day 1-2: [hazard ratio (HR) 1.21; 95% confidence interval (95% CI) 1.15-1.27, p < 0.001]; maximum lactate level day 1-2: (HR 1.07, 95% CI 1.02-1.12, p = 0.006); diabetes mellitus: (HR 1.91, 95% CI 1.23-3.03, p = 0.006) and appropriate antibiotics (HR 0.28, 95% CI 0.15-0.50, p < 0.001). Comparable results were obtained when other comorbid conditions were forced into the model. Diabetes impact was more pronounced in case of micro- or macro-angiopathy (HR 4.17, 95%CI 1.68-10.54, p = 0.003), in patients ≥ 65 years old (HR 2.59, 95% CI 1.56-4.28, < 0.001) and in those with body mass index (BMI) < 25 kg/m2 (HR 2.11, 95% CI 1.10-4.06, p = 0.025). CONCLUSIONS: Diabetes mellitus was the only comorbid condition which independently influenced mortality in patients with IPI. Its impact was more pronounced in patients with complications, aged ≥ 65 years and with BMI < 25 kg/m2.
PURPOSES: Streptococcus pneumoniae is a leading pathogen of severe community, hospital or nursing facility infections. We sought to describe characteristics of invasive pneumococcal infection (IPI) and pneumonia (due to the high mortality of intensive care-associated pneumonia) and to report outcomes according to various types of comorbidity. METHODS: Multicenter observational cohort study on the prospective Outcomerea database, including adult patients, with a hospital stay < 48 h before ICU admission and a documented IPI within the first 72 h of ICU admission. Comorbid conditions were defined according to the Knaus and Charlson classification. RESULTS: Of the 20,235 patients, 5310 (26.4%) had an invasive infection, including 560/5,310 (10.6%) who had an IPI. The ICU 28-day mortality was 109/560 (19.8%). Four factors were independently associated with mortality: SOFA day 1-2: [hazard ratio (HR) 1.21; 95% confidence interval (95% CI) 1.15-1.27, p < 0.001]; maximum lactate level day 1-2: (HR 1.07, 95% CI 1.02-1.12, p = 0.006); diabetes mellitus: (HR 1.91, 95% CI 1.23-3.03, p = 0.006) and appropriate antibiotics (HR 0.28, 95% CI 0.15-0.50, p < 0.001). Comparable results were obtained when other comorbid conditions were forced into the model. Diabetes impact was more pronounced in case of micro- or macro-angiopathy (HR 4.17, 95%CI 1.68-10.54, p = 0.003), in patients ≥ 65 years old (HR 2.59, 95% CI 1.56-4.28, < 0.001) and in those with body mass index (BMI) < 25 kg/m2 (HR 2.11, 95% CI 1.10-4.06, p = 0.025). CONCLUSIONS:Diabetes mellitus was the only comorbid condition which independently influenced mortality in patients with IPI. Its impact was more pronounced in patients with complications, aged ≥ 65 years and with BMI < 25 kg/m2.
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