Aetiology and outcome of severe community-acquired pneumonia.

Department of Thoracic Medicine, City Hospital, Nottingham, UK; Department of Microbiology and Public Health Laboratory Service Laboratory, Queen's Medical Centre, Nottingham, UK
Journal of Infection (Impact Factor: 4.07). 06/1985; 10(3):204-10. DOI: 10.1016/S0163-4453(85)92463-6
Source: PubMed

ABSTRACT Between January 1972 and December 1981, 50 patients with severe community-acquired pneumonia were admitted to the intensive care unit of a district general hospital. A causal pathogen was identified in 41 cases (82%). Streptococcus pneumoniae (16 cases), Legionella pneumophila (15 cases) and Staphylococcus aureus (5 cases) were the commonest. Assisted ventilation was required in 44 patients, of whom 25 died (57%). All 5 patients with staphylococcal pneumonia and 12(75%) with pneumococcal pneumonia died. Only 5 (33%) with Legionnaires' disease died. Mortality was significantly associated with age. Recommendations for the management of severe pneumonia are made.

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    ABSTRACT: ABSTRACT BACKGROUND In US and European literature Legionella pneumophila is reported as an important etiological agent of severe community acquired pneumonia (CAP), but in Chile this information is lacking. The aim of this study was to evaluate the incidence of severe CAP due for this agent in Santiago, Chile, and identify predictors of Legionella severe CAP. METHODS A multicentric prospective clinical study lasting 18 months was conducted; it included all adult patients who were admitted for a severe CAP in the Intensive Care Units (ICU) of 4 hospitals in Santiago. We excluded patients who were immunocompromised, had been hospitalized in the previous 4 weeks or presented another disease during their hospitalization. All data for the diagnosis of severe CAP were registered and urinary antigens for L pneumophila serogroup 1 were determined. RESULTS 104 patients with a severe CAP were included, mean age: 58.3 ±19.3 years; 64.4% males; APACHE II score was: 16.7± 6.3; SOFA: 6.1± 3.2, Pitt Bacteremia Score (PBS): 3.4± 2.5 and PaO2/FiO2: 170.8± 87.1. An etiologic agent was identified in 62 patients (59.6%): S. pneumoniae 27 (26%) and L. pneumophila 9 (8.6%) were the most frequent agents. Logistic regression analysis showed that plasma sodium ≤ 130 mEq/L was an independent predictor for L. pneumophila severe CAP (OR 11.3; 95% CI 2.5-50.5; p= 0.002). Global mortality was 26%, and 33% for L. pneumophila. PBS and Pneumonia Score Index were better predictors of mortality. CONCLUSIONS We found that in Santiago L. pneumophila was second to S. pneumoniae as etiological agent of severe CAP. Severe hyponatremia at admission appears as an indicator for L. pneumophila etiology in severe CAP.
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    ABSTRACT: Community-acquired pneumonia (CAP) exhibits mortality rates, between 20% and 50% in severe cases. Biomarkers are useful tools for searching for antibiotic therapy modifications and for CAP diagnosis, prognosis and follow-up treatment. This non-systematic state-of-the-art review presents the biological and clinical features of biomarkers in CAP patients, including procalcitonin, C-reactive protein, copeptin, pro-ANP (atrial natriuretic peptide), adrenomedullin, cortisol and D-dimers.
    Clinics (São Paulo, Brazil) 11/2012; 67(11):1321-5. · 1.59 Impact Factor
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    ABSTRACT: Community acquired pneumonia (CAP) is the most common infectious reason for admission to the Intensive Care Unit (ICU). The GenOSept study was designed to determine genetic influences on sepsis outcome. Phenotypic data was recorded using a robust clinical database allowing a contemporary analysis of the clinical characteristics, microbiology, outcomes and independent risk factors in patients with severe CAP admitted to ICUs across Europe. Kaplan-Meier analysis was used to determine mortality rates. A Cox Proportional Hazards (PH) model was used to identify variables independently associated with 28-day and six-month mortality. Data from 1166 patients admitted to 102 centres across 17 countries was extracted. Median age was 64 years, 62% were male. Mortality rate at 28 days was 17%, rising to 27% at six months. Streptococcus pneumoniae was the commonest organism isolated (28% of cases) with no organism identified in 36%. Independent risk factors associated with an increased risk of death at six months included APACHE II score (hazard ratio, HR, 1.03; confidence interval, CI, 1.01-1.05), bilateral pulmonary infiltrates (HR1.44; CI 1.11-1.87) and ventilator support (HR 3.04; CI 1.64-5.62). Haematocrit, pH and urine volume on day one were all associated with a worse outcome. The mortality rate in patients with severe CAP admitted to European ICUs was 27% at six months. Streptococcus pneumoniae was the commonest organism isolated. In many cases the infecting organism was not identified. Ventilator support, the presence of diffuse pulmonary infiltrates, lower haematocrit, urine volume and pH on admission were independent predictors of a worse outcome.
    Critical care (London, England) 04/2014; 18(2):R58. · 4.72 Impact Factor


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