title: Improvement of antibiotic therapy and ICU survival in severe non-pneumococcal community-acquired pneumonia: a matched case-control study.
abstract: BACKGROUND
  We aimed to compare intensive care unit mortality due to non-pneumococcal severe community-acquired pneumonia between the periods 2000-2002 and 2008-2014, and the impact of the improvement in antibiotic strategies on outcomes.
  
  
  METHODS
  This was a matched case-control study enrolling 144 patients with non-pneumococcal severe pneumonia: 72 patients from the 2000-2002 database (CAPUCI I group) were paired with 72 from the 2008-2014 period (CAPUCI II group), matched by the following variables: microorganism, shock at admission, invasive mechanical ventilation, immunocompromise, chronic obstructive pulmonary disease, and age over 65 years.
  
  
  RESULTS
  The most frequent microorganism was methicillin-susceptible Staphylococcus aureus (22.1%) followed by Legionella pneumophila and Haemophilus influenzae (each 20.7%); prevalence of shock was 59.7%, while 73.6% of patients needed invasive mechanical ventilation. Intensive care unit mortality was significantly lower in the CAPUCI II group (34.7% versus 16.7%; odds ratio (OR) 0.78, 95% confidence interval (CI) 0.64-0.95; p = 0.02). Appropriate therapy according to microorganism was 91.5% in CAPUCI I and 92.7% in CAPUCI II, while combined therapy and early antibiotic treatment were significantly higher in CAPUCI II (76.4 versus 90.3% and 37.5 versus 63.9%; p < 0.05). In the multivariate analysis, combined antibiotic therapy (OR 0.23, 95% CI 0.07-0.74) and early antibiotic treatment (OR 0.07, 95% CI 0.02-0.22) were independently associated with decreased intensive care unit mortality.
  
  
  CONCLUSIONS
  In non-pneumococcal severe community-acquired pneumonia , early antibiotic administration and use of combined antibiotic therapy were both associated with increased intensive care unit survival during the study period.
authors.affiliation: Critical Care Department, Vall d'Hebron Hospital, Ps. Vall d'Hebron, 119-129, Anexe AG-5a planta, 08035, Barcelona, Spain. gattarello@gmail.com.|Department of Medicine of the Universitat Autònoma de Barcelona, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain. gattarello@gmail.com.
authors.forename: Simone
authors.initials: S
authors.lastname: Gattarello
authors.affiliation: Critical Care Department, Vall d'Hebron Hospital, Ps. Vall d'Hebron, 119-129, Anexe AG-5a planta, 08035, Barcelona, Spain.|Department of Medicine of the Universitat Autònoma de Barcelona, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.
authors.forename: Leonel
authors.initials: L
authors.lastname: Lagunes
authors.affiliation: Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain.|Intensive Care Department, Donostia University Hospital, Donostia, Spain.
authors.forename: Loreto
authors.initials: L
authors.lastname: Vidaur
authors.affiliation: Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain.|Intensive Care Department, Dr. Negrin University Hospital, Las Palmas de Gran Canaria, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Solé-Violán
authors.affiliation: Intensive Care Department, Dr. Peset University Hospital, Valencia, Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: Zaragoza
authors.affiliation: Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain.|Critical Care Centre, Sabadell Hospital, Consorci Hospitalari Universitari Parc Taulí, Sabadell, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Vallés
authors.affiliation: Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain.|Respiratory Disease Department, Hospital Clinic i Provincial de Barcelona, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
authors.forename: Antoni
authors.initials: A
authors.lastname: Torres
authors.affiliation: Critical Care Unit, Puerta del Mar University Hospital, Cadiz, Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: Sierra
authors.affiliation: Intensive Care Department, Donostia University Hospital, Donostia, Spain.
authors.forename: Rosa
authors.initials: R
authors.lastname: Sebastian
authors.affiliation: Critical Care Department, Vall d'Hebron Hospital, Ps. Vall d'Hebron, 119-129, Anexe AG-5a planta, 08035, Barcelona, Spain.|Department of Medicine of the Universitat Autònoma de Barcelona, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.|Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Rello
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D016022:Case-Control Studies; D017714:Community-Acquired Infections; D004359:Drug Therapy, Combination; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000592:standards / Q000706:statistics & numerical data*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000188:drug therapy* / Q000401:mortality; D058996:Quality Improvement
chemical_list: D000900:Anti-Bacterial Agents