Epidemiological features and prognosis of severe community-acquired pneumococcal pneumonia.
OBJECTIVE
To describe risk factors of severe pneumococcal community-acquired pneumonia and to study variables influencing outcome.


METHODS
Retrospective (1987-1992) and prospective (1993-1995) study.


METHODS
Three participating ICUs from primary care hospitals.


METHODS
Five hundred and five patients (mean age: 63 +/- 17 years) with severe community-acquired pneumonia (CAP). Three groups of patients were defined: pneumococcal CAP (group 1), CAP with microbial diagnosis other than Streptococcus pneumoniae (group 2), CAP from group 2 and CAP without microbial diagnosis (group 3).


RESULTS
Admission data and data on the disease's course were recorded. The mean Simplified Acute Physiologic Score (SAPS) was 12.5 +/- 5.4. On admission 288 (57 %) patients were mechanically ventilated (mv) and 82 (16.2 %) required inotropic support. A microbial diagnosis was established for 309 (61.2%) patients. S. pneumoniae was isolated in 137 (27.1%) patients. Severe pneumococcal CAP was independently associated with male sex (p = 0.01), lack of antibiotics use before admission (p = 0.0001), non-aspiration pneumonia (p = 0.01) and septic shock (p = 0.0001). The overall mortality rate was 27.5 % (29.2 % in group 1). In patients with severe pneumococcal CAP, multivariate analysis showed that leukopenia less than 3,500/mm3 (p = 0.0004), age over 65 years (p = 0.01), septic shock (p = 0.01), sepsis related complications (p = 0.0001), ICU complications (p = 0.001) and inadequacy of antimicrobial therapy (p = 0.002) worsened the prognosis.


CONCLUSIONS
Few features facilitate the identification of pneumococcal CAP on ICU admission. The prognosis is mostly related to severity of illness (leukopenia, septic shock) while comorbidities do not seem to influence outcome. Sepsis-related disorders, ICU complications and adequate antimicrobial chemotherapy are the major variables affecting the outcome during an ICU stay.
Georges
H
H
Service de Réanimation Médicale et Maladies Infectieuses, Lille University Medical School, Centre Hospitalier, Tourcoing, France. bguery@compuserve.com
Leroy
O
O
Vandenbussche
C
C
Guery
B
B
Alfandari
S
S
Tronchon
L
L
Beaucaire
G
G
D018806:APACHE; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D017714:Community-Acquired Infections / Q000145:classification / Q000453:epidemiology / Q000401:mortality / Q000628:therapy; D015897:Comorbidity; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011018:Pneumonia, Pneumococcal / Q000145:classification / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D013296:Streptococcus pneumoniae / Q000302:isolation & purification; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents