Jean-Pierre Bedos1, Emmanuelle Varon2,3, Raphael Porcher4, Pierre Asfar5, Yves Le Tulzo6, Bruno Megarbane7, Armelle Mathonnet8, Anthony Dugard9, Anne Veinstein10, Kader Ouchenir11, Shidasp Siami12, Jean Reignier13, Arnaud Galbois14, Joël Cousson15, Sébastien Preau16, Olivier Baldesi17, Jean-Philippe Rigaud18, Bertrand Souweine19, Benoit Misset20, Frederic Jacobs21, Florent Dewavrin22, Jean-Paul Mira23. 1. Réanimation Médico-Chirurgicale, Hôpital A. Mignot, CH Versailles, 177 Rue de Versailles, 78157, Le Chesnay, France. jpbedos@ch-versailles.fr. 2. Laboratoire de Microbiologie, Centre National de Référence des Pneumocoques, AP-HP Hôpital Européen Georges-Pompidou, 75908, Paris Cedex 15, France. 3. Centre National de Référence des Pneumocoques, Centre Hospitalier Interrcommunal de Créteil, 94000, Créteil, France. 4. Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité (CRESS-UMR1153), Inserm/Université Paris Descartes, Centre d'épidémiologie clinique, Centre Equator France, Hôpital Hôtel-Dieu, 75004, Paris, France. 5. CHU Angers, Réanimation Médicale, 49933, Angers Cedex 9, France. 6. CHU Rennes, SMIRM, 35033, Rennes Cedex 9, France. 7. Hôpital Lariboisière, Réanimation Médicale et Toxicologique, 75010, Paris, France. 8. Hôpital de La Source, Réanimation Polyvalente, 45067, Orléans Cedex 2, France. 9. CHU Dupuytren, Réanimation Polyvalente, 87042, Limoges, France. 10. CHU Jean Bernard, Réanimation, 86021, Poitiers Cedex, France. 11. Hôpital Louis Pasteur, Réanimation, 28018, Chartres Cedex, France. 12. CH Sud Essonne, Réanimation Polyvalente, 91152, Etampes Cedex 02, France. 13. CHU Nantes, Réanimation Médicale, 44093, Nantes Cedex 1, France. 14. Hôpital St Antoine, Réanimation Médicale, 75012, Paris, France. 15. Hôpital Robert Debré, Réanimation Polyvalente, 51092, Reims Cedex, France. 16. Hôpital A. Calmette, Réanimation, 59037, Lille Cedex, France. 17. CH du Pays d'Aix, Réanimation, 13616, Aix En Provence, France. 18. CH Dieppe, Réanimation Polyvalente, 76202, Dieppe Cedex, France. 19. CHU Gabriel Montpied, Réanimation Médicale, 63000, Clermont Ferrand, France. 20. Hôpital Saint Joseph, Réanimation, 75014, Paris, France. 21. Hôpital Antoine Béclère, Réanimation Médicale, 92140, Clamart, France. 22. CH Valenciennes, Réanimation, 59300, Valenciennes, France. 23. Hôpital Cochin, Réanimation Médicale, 75679, Paris Cedex 14, France.
Abstract
PURPOSE: To assess the relative importance of host and bacterial factors associated with hospital mortality in patients admitted to the intensive care unit (ICU) for pneumococcal community-acquired pneumonia (PCAP). METHODS: Immunocompetent Caucasian ICU patients with PCAP documented by cultures and/or pneumococcal urinary antigen (UAg Sp) test were included in this multicenter prospective study between 2008 and 2012. All pneumococcal strains were serotyped. Logistic regression analyses were performed to identify risk factors for hospital mortality. RESULTS: Of the 614 patients, 278 (45%) had septic shock, 270 (44%) had bacteremia, 307 (50%) required mechanical ventilation at admission, and 161 (26%) had a diagnosis based only on the UAg Sp test. No strains were penicillin-resistant, but 23% had decreased susceptibility. Of the 36 serotypes identified, 7 accounted for 72% of the isolates, with different distributions according to age. Although antibiotics were consistently appropriate and were started within 6 h after admission in 454 (74%) patients, 116 (18.9%) patients died. Independent predictors of hospital mortality in the adjusted analysis were platelets ≤ 100 × 109/L (OR, 7.7; 95% CI, 2.8-21.1), McCabe score ≥ 2 (4.58; 1.61-13), age > 65 years (2.92; 1.49-5.74), lactates > 4 mmol/L (2.41; 1.27-4.56), male gender and septic shock (2.23; 1.30-3.83 for each), invasive mechanical ventilation (1.78; 1-3.19), and bilateral pneumonia (1.59; 1.02-2.47). Women with platelets ≤ 100 × 109/L had the highest mortality risk (adjusted OR, 7.7; 2.8-21). CONCLUSIONS: In critically ill patients with PCAP, age, gender, and organ failures at ICU admission were more strongly associated with hospital mortality than were comorbidities. Neither pneumococcal serotype nor antibiotic regimen was associated with hospital mortality.
PURPOSE: To assess the relative importance of host and bacterial factors associated with hospital mortality in patients admitted to the intensive care unit (ICU) for pneumococcal community-acquired pneumonia (PCAP). METHODS: Immunocompetent Caucasian ICU patients with PCAP documented by cultures and/or pneumococcal urinary antigen (UAg Sp) test were included in this multicenter prospective study between 2008 and 2012. All pneumococcal strains were serotyped. Logistic regression analyses were performed to identify risk factors for hospital mortality. RESULTS: Of the 614 patients, 278 (45%) had septic shock, 270 (44%) had bacteremia, 307 (50%) required mechanical ventilation at admission, and 161 (26%) had a diagnosis based only on the UAg Sp test. No strains were penicillin-resistant, but 23% had decreased susceptibility. Of the 36 serotypes identified, 7 accounted for 72% of the isolates, with different distributions according to age. Although antibiotics were consistently appropriate and were started within 6 h after admission in 454 (74%) patients, 116 (18.9%) patients died. Independent predictors of hospital mortality in the adjusted analysis were platelets ≤ 100 × 109/L (OR, 7.7; 95% CI, 2.8-21.1), McCabe score ≥ 2 (4.58; 1.61-13), age > 65 years (2.92; 1.49-5.74), lactates > 4 mmol/L (2.41; 1.27-4.56), male gender and septic shock (2.23; 1.30-3.83 for each), invasive mechanical ventilation (1.78; 1-3.19), and bilateral pneumonia (1.59; 1.02-2.47). Women with platelets ≤ 100 × 109/L had the highest mortality risk (adjusted OR, 7.7; 2.8-21). CONCLUSIONS: In critically illpatients with PCAP, age, gender, and organ failures at ICU admission were more strongly associated with hospital mortality than were comorbidities. Neither pneumococcal serotype nor antibiotic regimen was associated with hospital mortality.
Entities:
Keywords:
Fluoroquinolones; Intensive care unit; Macrolides; Pneumococcal pneumonia; Pneumococcal serotypes; Severe community-acquired pneumonia
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