Validation of the Infectious Diseases Society of America/American Thoracic Society criteria to predict severe community-acquired pneumonia caused by Streptococcus pneumoniae.
BACKGROUND
Severe community-acquired pneumonia (CAP) is usually defined as pneumonia that requires intensive care unit (ICU) admission; the primary pathogen responsible for ICU admission is Streptococcus pneumoniae. In this study, the 2007 Infectious Diseases Society of America/American Thoracic Society (IDSA/ATS) consensus criteria for ICU admission were compared with other severity scores in predicting ICU admission and mortality.


METHODS
We retrospectively studied 158 patients with pneumococcal CAP (1999-2003). Clinical and laboratory features at the emergency department were recorded and used to calculate the 2007 IDSA/ATS rule, the 2001 ATS rule, 2 modified 2007 IDSA/ATS rules, the Pneumonia Severity Index (PSI), and the CURB (confusion, urea, respiratory rate, blood pressure) score. The sensitivity, specificity, positive predictive value, and negative predictive value (NPV) were assessed for the various indices. We also determined the criteria that were independently predictive of ICU admission and of mortality in our population.


RESULTS
The 2007 IDSA/ATS criteria performed as well as the 2001 ATS rule in predicting ICU admission both demonstrated high sensitivity (90%) and NPV (97%). For the prediction of mortality, the best tool proved to be the PSI score (sensitivity, 95%; NPV, 99%). The variables associated with ICU admission in this patient population included tachypnea, confusion, Pao(2)/Fio(2) ratio of 250 or lower, and hypotension requiring fluid resuscitation. Mechanical ventilation and PSI class V were independently associated with mortality.


CONCLUSIONS
This study confirms the usefulness of the new criteria in predicting severe CAP. The 2001 ATS criteria seem an attractive alternative because they are simple and as effective as the 2007 IDSA/ATS criteria.
Division of Pulmonary/Critical Care, G. Papanikolaou Hospital, Thessaloniki, Greece. elikont@yahoo.gr
Paschalina
P
Kontou
Joseph L
JL
Kuti
David P
DP
Nicolau
D000368:Aged; D017714:Community-Acquired Infections / Q000175:diagnosis* / Q000382:microbiology / Q000401:mortality; D016638:Critical Illness; D004812:Epidemiologic Methods; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D018410:Pneumonia, Bacterial / Q000175:diagnosis* / Q000382:microbiology / Q000401:mortality; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D012955:Societies, Medical; D013290:Streptococcal Infections / Q000175:diagnosis* / Q000401:mortality; D013296:Streptococcus pneumoniae / Q000302:isolation & purification*; D014481:United States