title: Improved survival among ICU-hospitalized patients with community-acquired pneumonia by unidentified organisms: a multicenter case-control study.
abstract: A retrospective analysis from prospectively collected data was conducted in intensive care units (ICUs) at 33 hospitals in Europe comparing the trend in ICU survival among adults with severe community-acquired pneumonia (CAP) due to unknown organisms from 2000 to 2015. The secondary objective was to establish whether changes in antibiotic policies were associated with different outcomes. ICU mortality decreased (p = 0.02) from 26.9 % in the first study period (2000-2002) to 15.7 % in the second period (2008-2015). Demographic data and clinical severity at admission were comparable between groups, except for age over 65 years and incidence of cardiomyopathy. Over time, patients received higher rates of combination therapy (94.3 vs. 77.2 %; p < 0.01) and early (<3 h) antibiotic delivery (72.9 vs. 50.3 %; p < 0.01); likewise, the 2008-2015 group was more likely to receive adequate antibiotic prescription [as defined by the Infectious Diseases Society of America/American Thoracic Society (IDSA/ATS) guidelines] than the 2000-2002 group (70.7 vs. 48.2 %; p < 0.01). Multivariate analysis showed an independent association between decreased ICU mortality and early (<3 h) antibiotic administration [odds ratio (OR) 3.48 [1.70-7.15], p < 0.01] or adequate antibiotic prescription according to guidelines (OR 2.22 [1.11-4.43], p = 0.02). In conclusion, our findings suggest that ICU mortality in severe CAP due to unidentified organisms has decreased in the last 15 years. Several changes in management and better compliance with guidelines over time were associated with increased survival.
authors.affiliation: Universitat Autonoma de Barcelona, Barcelona, Spain. jrello@crips.es.|CIBERES, Barcelona, Spain. jrello@crips.es.
authors.forename: J
authors.initials: J
authors.lastname: Rello
authors.affiliation: CIBERES, Barcelona, Spain.|Hospital Joan XXIII, Tarragona, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Diaz
authors.affiliation: Hospital de Bellvitge, Barcelona, Spain.
authors.forename: R
authors.initials: R
authors.lastname: Mañez
authors.affiliation: CIBERES, Barcelona, Spain.|Hospital Negrin, Las Palmas de Gran Canaria, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Sole-Violan
authors.affiliation: CIBERES, Barcelona, Spain.|Hospital Parc Tauli, Sabadell, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Valles
authors.affiliation: CIBERES, Barcelona, Spain.|Hospital de Donostia, Donostia, Spain.
authors.forename: L
authors.initials: L
authors.lastname: Vidaur
authors.affiliation: Hospital Peset, Valencia, Spain.
authors.forename: R
authors.initials: R
authors.lastname: Zaragoza
authors.affiliation: Toronto General Hospital, Toronto, Canada.
authors.forename: S
authors.initials: S
authors.lastname: Gattarello
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016022:Case-Control Studies; D017714:Community-Acquired Infections / Q000401:mortality*; D004359:Drug Therapy, Combination / Q000379:methods; D005060:Europe / Q000453:epidemiology; D005260:Female; D006761:Hospitals; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000188:drug therapy / Q000401:mortality*; D011446:Prospective Studies; D012189:Retrospective Studies; D055502:Secondary Prevention / Q000379:methods; D016019:Survival Analysis
chemical_list: D000900:Anti-Bacterial Agents