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Critical Care
Published in: Critical Care 1/2015

Open Access 01-12-2015 | Research

Improvement of antibiotic therapy and ICU survival in severe non-pneumococcal community-acquired pneumonia: a matched case–control study

Authors: Simone Gattarello, Leonel Lagunes, Loreto Vidaur, Jordi Solé-Violán, Rafael Zaragoza, Jordi Vallés, Antoni Torres, Rafael Sierra, Rosa Sebastian, Jordi Rello

Published in: Critical Care | Issue 1/2015

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Abstract

Introduction

We aimed to compare intensive care unit mortality due to non-pneumococcal severe community-acquired pneumonia between the periods 2000–2002 and 2008–2014, and the impact of the improvement in antibiotic strategies on outcomes.

Methods

This was a matched case–control study enrolling 144 patients with non-pneumococcal severe pneumonia: 72 patients from the 2000–2002 database (CAPUCI I group) were paired with 72 from the 2008–2014 period (CAPUCI II group), matched by the following variables: microorganism, shock at admission, invasive mechanical ventilation, immunocompromise, chronic obstructive pulmonary disease, and age over 65 years.

Results

The most frequent microorganism was methicillin-susceptible Staphylococcus aureus (22.1 %) followed by Legionella pneumophila and Haemophilus influenzae (each 20.7 %); prevalence of shock was 59.7 %, while 73.6 % of patients needed invasive mechanical ventilation. Intensive care unit mortality was significantly lower in the CAPUCI II group (34.7 % versus 16.7 %; odds ratio (OR) 0.78, 95 % confidence interval (CI) 0.64–0.95; p = 0.02). Appropriate therapy according to microorganism was 91.5 % in CAPUCI I and 92.7 % in CAPUCI II, while combined therapy and early antibiotic treatment were significantly higher in CAPUCI II (76.4 versus 90.3 % and 37.5 versus 63.9 %; p < 0.05). In the multivariate analysis, combined antibiotic therapy (OR 0.23, 95 % CI 0.07–0.74) and early antibiotic treatment (OR 0.07, 95 % CI 0.02–0.22) were independently associated with decreased intensive care unit mortality.

Conclusions

In non-pneumococcal severe community-acquired pneumonia , early antibiotic administration and use of combined antibiotic therapy were both associated with increased intensive care unit survival during the study period.
Literature
1.
Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007;44:27–72.CrossRef
2.
Dombrovskiy VY, Martin AA, Sunderram J, Paz HL. Rapid increase in hospitalization and mortality rates for severe sepsis in the United States: a trend analysis from 1993 to 2003. Crit Care Med. 2007;35:1244–50.CrossRef
3.
Waterer GW, Kessler LA, Wunderink RG. Delayed administration of antibiotics and atypical presentation in community-acquired pneumonia. Chest. 2006;130:11–5.CrossRef
4.
Bordon J, Aliberti S, Duvvuri P, Wiemken T, Peyrani P, Natividad I, et al. Early administration of the first antimicrobials should be considered a marker of optimal care of patients with community-acquired pneumonia rather than a predictor of outcomes. Int J Infect Dis. 2013;17:e293–8.CrossRef
5.
Gaieski DF, Edwards JM, Kallan MJ, Carr BG. Benchmarking the incidence and mortality of severe sepsis in the United States. Crit Care Med. 2013;41:1167–74.CrossRef
6.
Kumar G, Kumar N, Taneja A, Kaleekal T, Tarima S, McGinley E, et al. Nationwide trends of severe sepsis in the 21st century (2000–2007). Chest. 2011;140:1223–31.CrossRef
7.
Vallés J, Palomar M, Alvárez-Lerma F, Rello J, Blanco A, Garnacho-Montero J, et al. Evolution over a 15-year period of clinical characteristics and outcomes of critically ill patients with community-acquired bacteraemia. Crit Care Med. 2013;41:76–83.CrossRef
8.
The Acute Respiratory Distress Syndrome Network. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med. 2000;342:1301–8.CrossRef
9.
Gattarello S, Borgatta B, Solé-Violán J, Vallés J, Vidaur L, Zaragoza R, et al. Decrease in mortality in severe community-acquired pneumococcal pneumonia: impact of improving antibiotic strategies (2000–2013). Chest. 2014;146:22–31.CrossRef
10.
Bodí M, Rodríguez A, Solé-Violán J, Gilavert MC, Garnacho J, Blanquer J, et al. Antibiotic prescription for community-acquired pneumonia in the intensive care unit: impact of adherence to Infectious Disease Society of America guidelines on survival. Clin Infect Dis. 2005;41:1709–16.CrossRef
11.
Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med. 1985;13:818–29.CrossRef
12.
Moreno RP, Metnitz PG, Almeida E, Jordan B, Bauer P, Campos RA, et al. SAPS 3: from evaluation of the patient to evaluation of the intensive care unit. Part 2: Development of a prognostic model for hospital mortality at ICU admission. Int Care Med. 2005;31:1345–55.CrossRef
13.
Langmore SE, Skarupski KA, Park PS, Fries BE. Predictors of aspiration pneumonia in nursing home residents. Dysphagia. 2002;17:298–307.CrossRef
14.
Lim WS, van der Eerden MM, Laing R, Boersma WG, Karalus N, Town GI, et al. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax. 2003;58:377–82.CrossRef
15.
Yoshimoto A, Nakamura H, Fujimura M, Nakao S. Severe community-acquired pneumonia in an intensive care unit: risk factors for mortality. Intern Med. 2005;44:710–6.CrossRef
16.
Arnold FW, Brock GN, Peyrani P, Rodríguez EL, Díaz AA, Rossi P, et al. Predictive accuracy of the pneumonia severity index vs CRB-65 for time to clinical stability: results from the Community-Acquired Pneumonia Organization (CAPO) International Cohort Study. Respir Med. 2010;104:1736–43.CrossRef
17.
Walden AP, Clarke GM, McKechnie S, Hutton P, Gordon AC, Rello J, et al. Patients with community-acquired pneumonia admitted to European intensive care units: an epidemiological survey of the GenOSept cohort. Crit Care. 2014;18:R58.CrossRef
18.
Baddour LM, Yu VL, Klugman KP, Feldman C, Ortqvist A, Rello J, et al. Combination antibiotic therapy lowers mortality among severely ill patients with Pneumococcal bacteraemia. Am J Respir Crit Care Med. 2004;170:440–4.CrossRef
19.
Rello J, Gattarello S, Souto J, Sole-Violan J, Valles J, Peredo R, et al. Community-acquired Legionella pneumonia in the intensive care unit: impact on survival of combined antibiotic therapy. Med Intensiva. 2013;37:320–6.CrossRef
20.
Dulhunty JM, Webb SA, Paterson DL, Bellomo R, Myburgh J, Roberts JA, et al. A survey of antibiotic prescribing practices in Australian and New Zealand intensive care units. Crit Care Resusc. 2010;12:162–70.PubMed
21.
Sligl WI, Asadi L, Eurich DT, Tjosvold L, Marrie TJ, Majumdar SR. Macrolides and mortality in critically ill patients with community-acquired pneumonia: a systematic review and meta-analysis. Crit Care Med. 2014;42:420–32.CrossRef
22.
Torres A, Garau J, Arvis P, Carlet J, Choudhri S, Kureishi A, et al. Moxifloxacin monotherapy is effective in hospitalized patients with community-acquired pneumonia: the MOTIV study—a randomized clinical trial. Clin Infect Dis. 2008;46:1499–509.CrossRef
23.
Heffelfinger JD, Dowell SF, Jorgensen JH, Klugman KP, Mabry LR, Musher DM, et al. Management of community-acquired pneumonia in the era of pneumococcal resistance: a report from the Drug-Resistant Streptococcus pneumoniae Therapeutic Working Group. Arch Intern Med. 2000;160:1399–408.CrossRef
24.
Grossman RF, Hsueh PR, Gillespie SH, Blasi F. Community-acquired pneumonia and tuberculosis: differential diagnosis and the use of fluoroquinolones. Int J Infect Dis. 2014;18:14–21.CrossRef
25.
Kumar A, Roberts D, Wood KE, Light B, Parrillo JE, Sharma S, et al. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med. 2006;34:1589–96.CrossRef
26.
Nobre V, Sarasin FP, Pugin J. Prompt antibiotic administration and goal-directed hemodynamic support in patients with severe sepsis and septic shock. Curr Opin Crit Care. 2007;13:586–91.CrossRef
27.
Rautanen A, Mills TC, Gordon AC, Hutton P, Steffens M, Nuamah R, et al. Genome-wide association study of survival from sepsis due to pneumonia: an observational cohort study. Lancet Respir Med. 2015;3:53–60.CrossRef
28.
Waterer GW. Better outcomes from pneumococcal pneumonia: how good is your care? Chest. 2014;146:6–8.CrossRef
Metadata
Title
Improvement of antibiotic therapy and ICU survival in severe non-pneumococcal community-acquired pneumonia: a matched case–control study
Authors
Simone Gattarello
Leonel Lagunes
Loreto Vidaur
Jordi Solé-Violán
Rafael Zaragoza
Jordi Vallés
Antoni Torres
Rafael Sierra
Rosa Sebastian
Jordi Rello
Publication date
01-12-2015
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2015
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-015-1051-1

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