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Annals of Intensive Care
Published in: Annals of Intensive Care 1/2018

Open Access 01-12-2018 | Research

Severe atypical pneumonia in critically ill patients: a retrospective multicenter study

Authors: S. Valade, L. Biard, V. Lemiale, L. Argaud, F. Pène, L. Papazian, F. Bruneel, A. Seguin, A. Kouatchet, J. Oziel, S. Rouleau, N. Bele, K. Razazi, O. Lesieur, F. Boissier, B. Megarbane, N. Bigé, N. Brulé, A. S. Moreau, A. Lautrette, O. Peyrony, P. Perez, J. Mayaux, E. Azoulay

Published in: Annals of Intensive Care | Issue 1/2018

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Abstract

Background

Chlamydophila pneumoniae (CP) and Mycoplasma pneumoniae (MP) patients could require intensive care unit (ICU) admission for acute respiratory failure.

Methods

Adults admitted between 2000 and 2015 to 20 French ICUs with proven atypical pneumonia were retrospectively described. Patients with MP were compared to Streptococcus pneumoniae (SP) pneumonia patients admitted to ICUs.

Results

A total of 104 patients were included, 71 men and 33 women, with a median age of 56 [44–67] years. MP was the causative agent for 76 (73%) patients and CP for 28 (27%) patients. Co-infection was documented for 18 patients (viruses for 8 [47%] patients). Median number of involved quadrants on chest X-ray was 2 [1–4], with alveolar opacities (n = 61, 75%), interstitial opacities (n = 32, 40%). Extra-pulmonary manifestations were present in 34 (33%) patients. Mechanical ventilation was required for 75 (72%) patients and vasopressors for 41 (39%) patients. ICU length of stay was 16.5 [9.5–30.5] days, and 11 (11%) patients died in the ICU. Compared with SP patients, MP patients had more extensive interstitial pneumonia, fewer pleural effusion, and a lower mortality rate [6 (8%) vs. 17 (22%), p = 0.013]. According MCA analysis, some characteristics at admission could discriminate MP and SP. MP was more often associated with hemolytic anemia, abdominal manifestations, and extensive chest radiograph abnormalities. SP-P was associated with shock, confusion, focal crackles, and focal consolidation.

Conclusion

In this descriptive study of atypical bacterial pneumonia requiring ICU admission, mortality was 11%. The comparison with SP pneumonia identified clinical, laboratory, and radiographic features that may suggest MP or CP pneumonia.
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Literature
1.
Cillóniz C, Torres A, Niederman M, van der Eerden M, Chalmers J, Welte T, et al. Community-acquired pneumonia related to intracellular pathogens. Intensive Care Med. 2016;42(9):1374–86.CrossRefPubMed
2.
Ngeow Y-F, Suwanjutha S, Chantarojanasriri T, Wang F, Saniel M, Alejandria M, et al. An Asian study on the prevalence of atypical respiratory pathogens in community-acquired pneumonia. Int J Infect Dis. 2005;9(3):144–53.CrossRefPubMed
3.
4.
von Baum H, Welte T, Marre R, Suttorp N, Lück C, Ewig S. Mycoplasma pneumoniae pneumonia revisited within the German Competence Network for Community-acquired pneumonia (CAPNETZ). BMC Infect Dis. 2009;9:62.CrossRef
5.
Marrie TJ. Mycoplasma pneumoniae pneumonia requiring hospitalization, with emphasis on infection in the elderly. Arch Intern Med. 1993;153(4):488–94.CrossRefPubMed
6.
Dumke R, Schnee C, Pletz MW, Rupp J, Jacobs E, Sachse K, et al. Mycoplasma pneumoniae and Chlamydia spp. infection in community-acquired pneumonia, Germany, 2011–2012. Emerg Infect Dis. 2015;21(3):426–34.CrossRefPubMedPubMedCentral
7.
Spoorenberg SM, Bos WJW, Heijligenberg R, Voorn PG, Grutters JC, Rijkers GT, et al. Microbial aetiology, outcomes, and costs of hospitalisation for community-acquired pneumonia; an observational analysis. BMC Infect Dis. 2014;17(14):335.CrossRef
8.
Sohn JW, Park SC, Choi Y-H, Woo HJ, Cho YK, Lee JS, et al. Atypical pathogens as etiologic agents in hospitalized patients with community-acquired pneumonia in Korea: a prospective multi-center study. J Korean Med Sci. 2006;21(4):602–7.CrossRefPubMedPubMedCentral
9.
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(2):R58.CrossRefPubMedPubMedCentral
10.
Gaillat J, Flahault A, deBarbeyrac B, Orfila J, Portier H, Ducroix J-P, et al. Community epidemiology of Chlamydia and Mycoplasma pneumoniae in LRTI in France over 29 months. Eur J Epidemiol. 2005;20(7):643–51.CrossRefPubMed
11.
Sopena N, Sabrià M, Pedro-Botet ML, Manterola JM, Matas L, Domínguez J, et al. Prospective study of community-acquired pneumonia of bacterial etiology in adults. Eur J Clin Microbiol Infect Dis. 1999;18(12):852–8.CrossRefPubMed
12.
Khoury T, Sviri S, Rmeileh AA, Nubani A, Abutbul A, Hoss S, et al. Increased rates of intensive care unit admission in patients with Mycoplasma pneumoniae: a retrospective study. Clin Microbiol Infect. 2016;22(8):711–4.CrossRefPubMed
13.
Cillóniz C, Ewig S, Ferrer M, Polverino E, Gabarrús A, de la Bellacasa JP, et al. Community-acquired polymicrobial pneumonia in the intensive care unit: aetiology and prognosis. Crit Care. 2011;15(5):R209.CrossRefPubMedPubMedCentral
14.
Lui G, Ip M, Lee N, Rainer TH, Man SY, Cockram CS, et al. Role of ‘atypical pathogens’ among adult hospitalized patients with community-acquired pneumonia. Respirol Carlton Vic. 2009;14(8):1098–105.CrossRef
15.
Miyashita N, Obase Y, Ouchi K, Kawasaki K, Kawai Y, Kobashi Y, et al. Clinical features of severe Mycoplasma pneumoniae pneumonia in adults admitted to an intensive care unit. J Med Microbiol. 2007;56(Pt 12):1625–9.CrossRefPubMed
16.
17.
Yin Y-D, Zhao F, Ren L-L, Song S-F, Liu Y-M, Zhang J-Z, et al. Evaluation of the Japanese Respiratory Society guidelines for the identification of Mycoplasma pneumoniae pneumonia. Respirol Carlton Vic. 2012;17(7):1131–6.CrossRef
18.
Guo Q, Li H-Y, Zhou Y-P, Li M, Chen X-K, Peng H-L, et al. Associations of radiological features in Mycoplasma pneumoniae pneumonia. Arch Med Sci AMS. 2014;10(4):725–32.PubMed
19.
Daxboeck F, Krause R, Wenisch C. Laboratory diagnosis of Mycoplasma pneumoniae infection. Clin Microbiol Infect. 2003;9(4):263–73.CrossRefPubMed
20.
Le Gall JR, Lemeshow S, Saulnier F. A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA. 1993;270(24):2957–63.CrossRefPubMed
21.
22.
Norisue Y, Tokuda Y, Koizumi M, Kishaba T, Miyagi S. Phasic characteristics of inspiratory crackles of bacterial and atypical pneumonia. Postgrad Med J. 2008;84(994):432–6.CrossRefPubMed
23.
Ruiz-González A, Falguera M, Vives M, Nogués A, Porcel JM, Rubio-Caballero M. Community-acquired pneumonia: development of a bedside predictive model and scoring system to identify the aetiology. Respir Med. 2000;94(5):505–10.CrossRefPubMed
24.
Menéndez R, Torres A, Reyes S, Zalacain R, Capelastegui A, Aspa J, et al. Initial management of pneumonia and sepsis: factors associated with improved outcome. Eur Respir J. 2012;39(1):156–62.CrossRefPubMed
25.
Medjo B, Atanaskovic-Markovic M, Radic S, Nikolic D, Lukac M, Djukic S. Mycoplasma pneumoniae as a causative agent of community-acquired pneumonia in children: clinical features and laboratory diagnosis. Ital J Pediatr. 2014;18(40):104.CrossRef
Metadata
Title
Severe atypical pneumonia in critically ill patients: a retrospective multicenter study
Authors
S. Valade
L. Biard
V. Lemiale
L. Argaud
F. Pène
L. Papazian
F. Bruneel
A. Seguin
A. Kouatchet
J. Oziel
S. Rouleau
N. Bele
K. Razazi
O. Lesieur
F. Boissier
B. Megarbane
N. Bigé
N. Brulé
A. S. Moreau
A. Lautrette
O. Peyrony
P. Perez
J. Mayaux
E. Azoulay
Publication date
01-12-2018
Publisher
Springer International Publishing
Published in
Annals of Intensive Care / Issue 1/2018
Electronic ISSN: 2110-5820
DOI
https://doi.org/10.1186/s13613-018-0429-z

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