title: Risks of nonsteroidal antiinflammatory drugs in undiagnosed intensive care unit pneumococcal pneumonia: younger and more severely affected patients.
abstract: OBJECTIVE
  The purpose of this study is to investigate whether exposure to nonsteroidal antiinflammatory drugs (NSAIDs) at the early stage of severe pneumococcal community-acquired pneumonia (CAP) requiring intensive care unit (ICU) admission may affect its presentation and outcome.
  
  
  METHODS
  Medical records of ICU adult patients (12-year period) with a pneumococcal CAP diagnosis were retrospectively analyzed according to previous NSAID exposure.
  
  
  RESULTS
  One hundred six confirmed pneumococcal CAP were identified, 20 received NSAIDs within 4 (2-6) days before admission. Nonsteroidal antiinflammatory drug-exposed patients were younger (43.3 vs 62.2 years; P < .0001), had less frequently at least one chronic comorbid condition (40% vs 75%; P = .003), had more often complicated pleural effusions (20% vs 2.3%; P = .01), and more frequent pleuropulmonary complications (odds ratio: 5.75 [1.97-16.76]). Nonsteroidal antiinflammatory drug patients required more often noninvasive ventilatory support (25% vs 4.6%; P = .003). Intensive care unit length of stay and mortality were similar.
  
  
  CONCLUSIONS
  We report as severe pneumococcal pneumonia in young and healthy patients exposed to NSAIDs as in older, more comorbid, and nonexposed ones. Nonsteroidal antiinflammatory drug use may mask initial symptoms and delay antimicrobial therapy, thus predisposing to worse outcomes.
authors.affiliation: AP-HP, Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, 178 rue des Renouillers, Colombes, France F-92700; IAME, UMR 1137, INSERM, Paris, France F-75018; IAME, UMR 1137, Univ Paris Diderot, Sorbonne Paris Cité, Paris, France F-75018.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Messika
authors.affiliation: AP-HP, Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, 178 rue des Renouillers, Colombes, France F-92700.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Sztrymf
authors.affiliation: AP-HP, Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, 178 rue des Renouillers, Colombes, France F-92700.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Bertrand
authors.affiliation: IAME, UMR 1137, INSERM, Paris, France F-75018; IAME, UMR 1137, Univ Paris Diderot, Sorbonne Paris Cité, Paris, France F-75018; AP-HP, Hôpital Louis Mourier, Service de Microbiologie, 178 rue des Renouillers, Colombes, France F-92700.
authors.forename: Typhaine
authors.initials: T
authors.lastname: Billard-Pomares
authors.affiliation: AP-HP, Hôpital Louis Mourier, Service de Microbiologie, 178 rue des Renouillers, Colombes, France F-92700.
authors.forename: Guilene
authors.initials: G
authors.lastname: Barnaud
authors.affiliation: IAME, UMR 1137, INSERM, Paris, France F-75018; IAME, UMR 1137, Univ Paris Diderot, Sorbonne Paris Cité, Paris, France F-75018; AP-HP, Hôpital Louis Mourier, Service de Microbiologie, 178 rue des Renouillers, Colombes, France F-92700.
authors.forename: Catherine
authors.initials: C
authors.lastname: Branger
authors.affiliation: AP-HP, Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, 178 rue des Renouillers, Colombes, France F-92700; IAME, UMR 1137, INSERM, Paris, France F-75018; IAME, UMR 1137, Univ Paris Diderot, Sorbonne Paris Cité, Paris, France F-75018.
authors.forename: Didier
authors.initials: D
authors.lastname: Dreyfuss
authors.affiliation: AP-HP, Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, 178 rue des Renouillers, Colombes, France F-92700; IAME, UMR 1137, INSERM, Paris, France F-75018; IAME, UMR 1137, Univ Paris Diderot, Sorbonne Paris Cité, Paris, France F-75018. Electronic address: jean-damien.ricard@lmr.aphp.fr.
authors.forename: Jean-Damien
authors.initials: JD
authors.lastname: Ricard
mesh_terms: D018806:APACHE; D000328:Adult; D000367:Age Factors; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal; D017714:Community-Acquired Infections / Q000150:complications / Q000188:drug therapy / Q000401:mortality; D015897:Comorbidity; D000075202:Contraindications; D005260:Female; D006760:Hospitalization; D006801:Humans; D057970:Inappropriate Prescribing / Q000009:adverse effects; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D063087:Noninvasive Ventilation; D010996:Pleural Effusion / Q000175:diagnosis; D011018:Pneumonia, Pneumococcal / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D011446:Prospective Studies; D012189:Retrospective Studies; D012306:Risk; D013296:Streptococcus pneumoniae / Q000302:isolation & purification
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal
keywords: ICU outcome; Nonsteroidal antiinflammatory drug; Pleural effusion; Streptococcus pneumonia; severe community-acquired pneumonia