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

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

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Abstract

© 2015 Gattarello et al. 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.
Original languageEnglish
Article number335
JournalCritical Care
Volume19
Issue number1
DOIs
Publication statusPublished - 10 Sep 2015

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    Gattarello, S., Lagunes, L., Vidaur, L., Solé-Violán, J., Zaragoza, R., Vallés, J., Torres, A., Sierra, R., Sebastian, R., & Rello, J. (2015). Improvement of antibiotic therapy and ICU survival in severe non-pneumococcal community-acquired pneumonia: A matched case-control study. Critical Care, 19(1), [335]. https://doi.org/10.1186/s13054-015-1051-1