title: Evolution over a 15-year period of the clinical characteristics and outcomes of critically ill patients with severe community-acquired pneumonia.
abstract: OBJECTIVE
  To study the characteristics and outcomes of patients in the ICU with severe community-acquired pneumonia (SCAP) over a 15-year surveillance period.
  
  
  METHODS
  We conducted a retrospective cohort study of episodes of SCAP, and assessed the epidemiology, etiology, treatment and outcomes of patients admitted to the ICU, comparing three periods (1999-2003, 2004-2008 and 2009-2013).
  
  
  RESULTS
  A total of 458 patients were diagnosed with SCAP. The overall cumulative incidence was 37.4 episodes/1000 admissions, with a progressive increase over the three periods (P<0.001). Patients fulfilling the two major IDSA/ATS criteria at admission increased from 64.2% in the first period to 82.5% in the last period (P=0.005). Streptococcus pneumoniae was the prevalent pathogen. The incidence of bacteremia was 23.1%, and a progressive significant reduction in overall incidence was observed over the three periods (P=0.02). Globally, 91% of the patients received appropriate empiric antibiotic treatment, increasing from 78.3% in the first period to 97.7% in the last period (P<0.001). Combination antibiotic therapy (betalactam+macrolide or fluoroquinolone) increased significantly from the first period (61%) to the last period (81.3%) (P<0.001). Global ICU mortality was 25.1%, and decreased over the three periods (P=0.001).
  
  
  CONCLUSIONS
  Despite a progressively higher incidence and severity of SCAP in our ICU, crude ICU mortality decreased by 18%. The increased use of combined antibiotic therapy and the decreasing rates of bacteremia were associated to improved patient prognosis.
authors.affiliation: Critical Care Department, Hospital Sabadell, Corporació Sanitària Universitària Parc Taulí, Sabadell, Barcelona, Spain; Universidad Autonoma de Barcelona, Bellaterra, Barcelona, Spain; CIBER Enfermedades Respiratorias, Spain. Electronic address: jvalles@tauli.cat.
authors.forename: J
authors.initials: J
authors.lastname: Vallés
authors.affiliation: Critical Care Department, Hospital Sabadell, Corporació Sanitària Universitària Parc Taulí, Sabadell, Barcelona, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Diaz
authors.affiliation: CIBER Enfermedades Respiratorias, Spain; Critical Care Department, Hospital St. James, Dublin, Ireland.
authors.forename: I
authors.initials: I
authors.lastname: Martín-Loeches
authors.affiliation: Critical Care Department, Hospital Sabadell, Corporació Sanitària Universitària Parc Taulí, Sabadell, Barcelona, Spain.
authors.forename: N
authors.initials: N
authors.lastname: Bacelar
authors.affiliation: Critical Care Department, Hospital Sabadell, Corporació Sanitària Universitària Parc Taulí, Sabadell, Barcelona, Spain.
authors.forename: P
authors.initials: P
authors.lastname: Saludes
authors.affiliation: Critical Care Department, Hospital Sabadell, Corporació Sanitària Universitària Parc Taulí, Sabadell, Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Lema
authors.affiliation: Respiratory Department, Hospital Sabadell, Corporació Sanitària Universitària Parc Taulí, Sabadell, Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Gallego
authors.affiliation: Universidad Autonoma de Barcelona, Bellaterra, Barcelona, Spain; Microbiology Department, Hospital Sabadell, Corporació Sanitària Universitària Parc Taulí, Sabadell, Barcelona, Spain.
authors.forename: D
authors.initials: D
authors.lastname: Fontanals
authors.affiliation: Critical Care Department, Hospital Sabadell, Corporació Sanitària Universitària Parc Taulí, Sabadell, Barcelona, Spain; Universidad Autonoma de Barcelona, Bellaterra, Barcelona, Spain; CIBER Enfermedades Respiratorias, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Artigas
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000453:epidemiology; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D015897:Comorbidity; D016638:Critical Illness / Q000453:epidemiology*; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D018410:Pneumonia, Bacterial / Q000188:drug therapy / Q000453:epidemiology*; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013030:Spain / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents
keywords: Bacteremia; Bacteriemia; Community-acquired pneumonia; Critically ill patient; ICU; Mechanical ventilation; Neumonía comunitaria; Paciente crítico; Shock; Unidad de cuidados intensivos; Ventilación mecánica