OBJECTIVE: The objective of the present study was to compare antibiotic prescribing practices and survival in the ICU for patients with pneumococcal severe community-acquired pneumonia (SCAP) between 2000 and 2013. METHODS: This was a matched case-control study of two prospectively recorded cohorts in Europe. Eighty patients from the Community-Acquired Pneumonia en la Unidad de Cuidados Intensivos (CAPUCI) II study (case group) were matched with 80 patients from CAPUCI I (control group) based on the following: shock at admission, need of mechanical ventilation, COPD, immunosuppression, and age. R ESULTS: Demographic data were comparable in the two groups. Combined antibiotic therapy increased from 66.2% to 87.5% ( P < .01), and the percentage of patients receiving the first dose of antibiotic within 3 h increased from 27.5% to 70.0% ( P < .01). ICU mortality was signifi- cantly lower (OR, 0.82; 95% CI, 0.68-0.98) in cases, both in the whole population and in the subgroups of patients with shock (OR, 0.67; 95% CI, 0.50-0.89) or receiving mechanical ventilation (OR, 0.73; 95% CI, 0.55-0.96). In the multivariate analysis, ICU mortality increased in patients requiring mechanical ventilation (OR, 5.23; 95% CI, 1.60-17.17) and decreased in patients receiving early antibiotic treatment (OR, 0.36; 95% CI, 0.15-0.87) and combined therapy (OR, 0.19; 95% CI, 0.07-0.51). CONCLUSIONS: In pneumococcal SCAP, early antibiotic prescription and use of combination therapy increased. Both were associated with improved survival. © 2014 AMERICAN COLLEGE OF CHEST PHYSICIANS.
|Publication status||Published - 1 Jan 2014|
Gattarello, S., Borgatta, B., Solé-Violán, J., Vallés, J., Vidaur, L., Zaragoza, R., Torres, A., & Rello, J. (2014). Decrease in Mortality in severe community-acquired pneumococcal pneumonia: Impact of improving antibiotic strategies (2000-2013). Chest, 146(1), 22-31. https://doi.org/10.1378/chest.13-1531