Nonsteroidal antiinflammatory drugs may affect the presentation and course of community-acquired pneumonia.
BACKGROUND
Nonsteroidal antiinflammatory drugs (NSAIDs) are commonly used as antipyretics and analgesics and may affect the host response to acute infection. We investigated the potential influence of NSAIDs on the presentation and short-term outcomes of nonimmunocompromised inpatients with community-acquired pneumonia (CAP) admitted to the ICU.


METHODS
All consecutive patients with CAP admitted to the ICU or step-down unit of a university hospital during a 4-year period were prospectively included, except when receiving long-term NSAIDs or steroids. Drug exposures, presentation, and hospital course were recorded.


RESULTS
Of the 90 patients included, 32 (36%) had taken NSAIDs prior to hospital referral. Compared with nonexposed patients, they were younger and had fewer comorbidities but similar severity of disease at presentation, despite a longer duration of symptoms before referral. However, they more often developed pleuropulmonary complications, such as pleural empyema and lung cavitation (37.5% vs 7%; P = .0009), and had a trend to more-invasive disease, with a higher frequency of pleural empyema (25% vs 5%, P = .014) and bacteremia, especially in those not having received concomitant antibiotics (69% vs 27%, P = .009). Nevertheless, the patients in the NSAID group had no more severe systemic inflammation or remote organ dysfunction. In multivariable analyses, NSAID exposure was independently associated with the occurrence of pleuropulmonary complications (OR, 8.1; 95% CI, 2.3-28).


CONCLUSIONS
Our findings suggest that NSAID exposure at the early stage of CAP is associated with a more complicated course but a blunted systemic response, which may be associated with a delayed diagnosis and a protracted course.
Voiriot
Guillaume
G
Service de Pneumologie et Réanimation, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France.
Dury
Sandra
S
Service de Pneumologie et Réanimation, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France.
Parrot
Antoine
A
Service de Pneumologie et Réanimation, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France.
Mayaud
Charles
C
Service de Pneumologie et Réanimation, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France; Université Pierre et Marie Curie, Paris, France.
Fartoukh
Muriel
M
Service de Pneumologie et Réanimation, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France. Electronic address: muriel.fartoukh@tnn.aphp.fr.
D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000494:pharmacology*; D058633:Antipyretics / Q000494:pharmacology*; D016009:Chi-Square Distribution; D017714:Community-Acquired Infections / Q000150:complications / Q000188:drug therapy*; D015897:Comorbidity; D005260:Female; D005602:France; D006801:Humans; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011014:Pneumonia / Q000150:complications / Q000188:drug therapy*; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
D000894:Anti-Inflammatory Agents, Non-Steroidal; D058633:Antipyretics