A 7-year study of severe hospital-acquired pneumonia requiring ICU admission

Jordi Vallés, Eduard Mesalles, Dolors Mariscal, Ma Del Mar Fernández, Rocío Peña, José Luis Jiménez, Jordi Rello

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60 Citations (Scopus)

Abstract

Objective: To examine the characteristics, prognostic factors, and outcome of patients with severe hospital-acquired pneumonia admitted to the ICU. Design and setting: Prospective observational clinical study in two medical-surgical ICUs with 16 and 20 beds. Patients and participants: During a 7-year period all hospitalized patients requiring admission to either ICU for hospital-acquired pneumonia were followed up. Measurements and results: We diagnosed 96 episodes of severe hospital-acquired pneumonia, and in 67 cases a causal diagnosis was made. Most episodes were late-onset pneumonia. Gram-negative micro-organisms were isolated in 51% of episodes diagnosed, and Pseudomonas aeruginosa was the most frequent pathogen isolated (24%). Clearly significant variations happened between hospitals, particularly affecting the incidence of Aspergillus spp. and Legionella pneumophila. Forty-nine patients developed septic shock (51%). Fifty-one patients died (53%). Aspergillosis and pneumonia due to P. aeruginosa were associated with the highest mortality. Septic shock (OR: 14.27) and chronic obstructive pulmonary disease (OR: 6.11) were independently associated with a poor prognosis. Conclusions: Patients with severe hospital-acquired pneumonia admitted to the ICU present high mortality. The presence of septic shock and chronic obstructive pulmonary disease in conjunction with specific microorganisms are associated with a poor prognosis. Local epidemiological data combined with a patient-based approach may allow a more accurate therapy decision making.
Original languageEnglish
Pages (from-to)1981-1988
JournalIntensive Care Medicine
Volume29
Issue number11
DOIs
Publication statusPublished - 1 Nov 2003

Keywords

  • Hospital-acquired infection
  • Intensive care unit
  • Pneumonia

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