A 7-year study of severe hospital-acquired pneumonia requiring ICU admission.
OBJECTIVE
To examine the characteristics, prognostic factors, and outcome of patients with severe hospital-acquired pneumonia admitted to the ICU.


METHODS
Prospective observational clinical study in two medical-surgical ICUs with 16 and 20 beds


METHODS
During a 7-year period all hospitalized patients requiring admission to either ICU for hospital-acquired pneumonia were followed up.


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.
D018806:APACHE; D000368:Aged; D015897:Comorbidity; D003428:Cross Infection / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D005260:Female; D017052:Hospital Mortality; D006785:Hospitals, University; D006801:Humans; D015994:Incidence; D017053:Infection Control; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010343:Patient Admission / Q000706:statistics & numerical data*; D011014:Pneumonia / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D011379:Prognosis; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications; D012307:Risk Factors; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000150:complications; D013030:Spain / Q000453:epidemiology; D016896:Treatment Outcome