A prospective cogitation of 132 patients with unrelenting community-acquired pneumonia (CAP) treated in the ICU was carried not at home to determine the causative agents.

A prospective cogitation of 132 patients with unrelenting community-acquired pneumonia (CAP) treated in the ICU was carried not at home to determine the causative agents, the value of the clinical, biological, and radiologic features in predicting the etiology, and to define prognostic factors. The subject of attention group included 98 men and 34 women (mean age: 58 [+ or -] 18 years). The mostly frequent underlying condition was COPD (51 patients, 39 percent) forward admission, 35 patients were in clash 71 were mentally confused, and 81 (61 percent) required mechanical ventilation during their hospitalization. The clinical, laboratory, and radiologic parameters were of little value for predicting the etiology in patients with relentless CAP. An etiologic diagnosis was made in 95 (72 percent) patients. The mostly frequent pathogens were Streptococcus pneumoniae (43 cases [45 percent]) Gram-negative bacilli (14 cases [15 percent]) and Haemophilus influenzae (14 cases [15 percent]) Mortality was 24 percent It was significantly associated with a age more than 60 years, septic concussion impairment of alertness, mechanical ventilation requirement, bacteremic pneumonia, and s pneumoniae or Enterobacteriaceae as the causes of the pneumonia. Recommendations for antibiotic chemotherapy in patients with chaste CAP admitted the ICU are included.

Community-acquired pneumonia (CAP) continues to be a major cause of morbidity and mortality. Despite the availability of adequate antimicrobial agents to treat the illness, it is generally the fifth most common cause of death, and undivided of the first among infectious diseases in the United States.[1] Approximately 18 to 36 percent of patients with CAP needing hospitalization require ICU treatment,[2,3] among whom a mortality rate of 47 to 76 percent has been reported.[4,5] There still are difficulties in the management of hard CAP despite improvements in diagnostic techniques athwart the last few years. Because of the seriousness of the illness, it is necessary to start treatment before an etiologic diagnosis has been made. The choice of the initial treatment ofttimes is empirical, being supported from knowledge of epidemiologic, clinical, and radiologic data and the eventuates of staining bacteriologic samples with the Gram stain among others. The main objective of this multicenter prospective reflection was to assess the epidemiology and history of patients afflictively ill with CAP requiring treatment in the ICU. As a secondary goal, a prognostic investigation was carried out, attempting to define a subset of patients with a high risk of death.

arrangements AND MATERIALS

Clinical Data

From June 1987 to December 1989 132 consecutive patients with peremptory CAP requiring hospitalization in the ICU were prospectively included in this close attention There were 15 French participating center Pneumonia was defined as any acute septic episode with respiratory symptoms and radiologic pulmonary shadowing, which was neither preexisting nor of other known cause. All nonimmunocompromised adults (15 years or older) with a simplified acute physiologic score (SAPS)[6] of 8 or above were eligible. Patients with chronic bronchitis or emphysema who expanded pneumonia (acute septic illness with radiographic worsening or with evidence of a strange infiltrate) were included. Patients with pulmonary tuberculosis or pulmonary edema were exclud as were patients with lymphoma, cancer, organ transplantation, and treatment with corticosteroids or immunosuppressants. Human immunodeficiency virus-positive patients and those suffering from aplasia and hypogammaglobulinemia also were excluded

For each case, a questionnaire was filled public reporting medical symptoms and signs forward admission, in addition to radiologic and laboratory findings. Clinical parameters during the first 24 h also were noted. Each token of bronchopulmonary sampling (expectorated sputum [ES] transtracheal aspiration [TTA], distal guarded aspiration--Matthew's method[7] [DPA], or plugg telescoping catheter [PTC]-brush Wimberley's method[89]) as well as life-current cultures, cultures of pleural effusions or cerebrospinal fluid, direct immunofluorescence for Legionella, soluble antigen detection for pneumococcal antigen from latex agglutination, serologic tests for Mycoplasma pneumoniae, Chlamydia, Legionella species, Rickettsia, or virus (regarding influenza virus image A and B, parainfluenza virus, adenovirus, respiratory syncytial virus) were not required yet recommended. The ES, TTA, and DPA samples were submitted to the local microbiology laboratory, where refinements (quantitative cultures for TTA or DPA) and Gram stains were performed. Each center carried without its own serologic tests. The choice of antibiotics was left to the discretion of each center based onward the Gram stain results.

Etiologic Diagnosis

All line culture isolates were considered to be etiologic agents of the pneumonia, leaving out for Staphylococcus aureus and aerobic Gram-negative bacteria (Enterobacteriaceae and Pseudomonadaceae), which in addition were required to be isolated from the bronchopulmonary sample. All pleural fluid refinement isolates were considered to be the cause of the pneumonia.

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