title: Decrease in mortality in severe community-acquired pneumococcal pneumonia: impact of improving antibiotic strategies (2000-2013).
abstract: OBJECTIVE
  The objective of the present study was to compare antibiotic prescribing practices and survival in the ICU for patients with pneumococcal severe community-acquired pneumonia (SCAP) between 2000 and 2013.
  
  
  METHODS
  This was a matched case-control study of two prospectively recorded cohorts in Europe. Eighty patients from the Community-Acquired Pneumonia en la Unidad de Cuidados Intensivos (CAPUCI) II study (case group) were matched with 80 patients from CAPUCI I (control group) based on the following: shock at admission, need of mechanical ventilation, COPD, immunosuppression, and age.
  
  
  RESULTS
  Demographic data were comparable in the two groups. Combined antibiotic therapy increased from 66.2% to 87.5% (P < .01), and the percentage of patients receiving the first dose of antibiotic within 3 h increased from 27.5% to 70.0% (P < .01). ICU mortality was significantly lower (OR, 0.82; 95% CI, 0.68-0.98) in cases, both in the whole population and in the subgroups of patients with shock (OR, 0.67; 95% CI, 0.50-0.89) or receiving mechanical ventilation (OR, 0.73; 95% CI, 0.55-0.96). In the multivariate analysis, ICU mortality increased in patients requiring mechanical ventilation (OR, 5.23; 95% CI, 1.60-17.17) and decreased in patients receiving early antibiotic treatment (OR, 0.36; 95% CI, 0.15-0.87) and combined therapy (OR, 0.19; 95% CI, 0.07-0.51).
  
  
  CONCLUSIONS
  In pneumococcal SCAP, early antibiotic prescription and use of combination therapy increased. Both were associated with improved survival.
authors.affiliation: Critical Care Department, Vall d'Hebron Hospital, Universitat Autonoma de Barcelona and Medicine Department, Vall d'Hebron Institut de Recerca (VHIR), Barcelona. Electronic address: gattarello@gmail.com.
authors.forename: Simone
authors.initials: S
authors.lastname: Gattarello
authors.affiliation: Critical Care Department, Vall d'Hebron Hospital, Universitat Autonoma de Barcelona and Medicine Department, Vall d'Hebron Institut de Recerca (VHIR), Barcelona.
authors.forename: Bárbara
authors.initials: B
authors.lastname: Borgatta
authors.affiliation: Intensive Care Unit, Dr Negrin University Hospital, Las Palmas de Gran Canaria, Sabadell; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Bunyola, Islas Baleares, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Solé-Violán
authors.affiliation: Critical Care Center, Sabadell Hospital, Consorci Hospitalari Universitari Parc Taulí, Sabadell; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Bunyola, Islas Baleares, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Vallés
authors.affiliation: Intensive Care Department, Donostia Hospital, Donostia; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Bunyola, Islas Baleares, Spain.
authors.forename: Loreto
authors.initials: L
authors.lastname: Vidaur
authors.affiliation: Intensive Care Department, Dr Peset University Hospital, Valencia.
authors.forename: Rafael
authors.initials: R
authors.lastname: Zaragoza
authors.affiliation: Respiratory Disease Department, Hospital Clínic i Provincial de Barcelona, University of Barcelona, Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Bunyola, Islas Baleares, Spain.
authors.forename: Antoni
authors.initials: A
authors.lastname: Torres
authors.affiliation: Critical Care Department, Vall d'Hebron Hospital, Universitat Autonoma de Barcelona and Medicine Department, Vall d'Hebron Institut de Recerca (VHIR), Barcelona; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Bunyola, Islas Baleares, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Rello
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016022:Case-Control Studies; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011018:Pneumonia, Pneumococcal / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D017410:Practice Guidelines as Topic / Q000592:standards*; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents