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Clinical manifestations of pneumonia according to the causative organism in patients in the intensive care unit

  • Lee, Jung-Kyu (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital) ;
  • Lee, Jinwoo (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital) ;
  • Park, Young Sik (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital) ;
  • Lee, Chang Hoon (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital) ;
  • Yim, Jae-Joon (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital) ;
  • Yoo, Chul-Gyu (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital) ;
  • Kim, Young Whan (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital) ;
  • Han, Sung Koo (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital) ;
  • Lee, Sang-Min (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital)
  • Received : 2014.05.14
  • Accepted : 2014.10.08
  • Published : 2015.11.01

Abstract

Background/Aims: Whether the causative organism influences the clinical course of pneumonia in the intensive care unit (ICU) is controversial. We assessed the clinical manifestations and prognosis of pneumonia according to the causative pathogens in patients in a medical ICU. Methods: A retrospective observational study was performed in a medical ICU. Among 242 patients who were admitted to the ICU, 103 who were treated for pneumonia were analyzed. Results: The causative pathogen was identified in 50 patients (49.0%); 22 patients (21.6%) had multidrug-resistant (MDR) pathogens. The distribution of causative micro-organisms was Staphylococcus aureus (20%), Pseudomonas species (16%), Klebsiella pneumoniae (14%), and Acinetobacter baumannii (12%). No significant difference in ICU mortality rate, duration of ICU stay, duration of mechanical ventilation, or frequencies of re-intubation and tracheostomy were detected based on the identification of any pathogen. In sub-analyses according to the pneumonia classification, the number of pathogens identified did not differ between pneumonia types, and a higher incidence of identified MDR pathogens was detected in the hospital-acquired pneumonia group than in the community-acquired or healthcare-acquired pneumonia groups. However, the clinical outcomes of pneumonia according to identification status and type of pathogen did not differ significantly between the groups. Conclusions: Neither the causative micro-organism nor the existence of MDR pathogens in critically ill patients with pneumonia was associated with the clinical outcome of pneumonia, including ICU mortality. This result was consistent regardless of the pneumonia classification.

Keywords

References

  1. Richards MJ, Edwards JR, Culver DH, Gaynes RP. Nosocomial infections in medical intensive care units in the United States: National Nosocomial Infections Surveillance System. Crit Care Med 1999;27:887-892. https://doi.org/10.1097/00003246-199905000-00020
  2. Torres A, Aznar R, Gatell JM, et al. Incidence, risk, and prognosis factors of nosocomial pneumonia in mechanically ventilated patients. Am Rev Respir Dis 1990;142:523-528. https://doi.org/10.1164/ajrccm/142.3.523
  3. Kung HC, Hoyert DL, Xu J, Murphy SL. Deaths: final data for 2005. Natl Vital Stat Rep 2008;56:1-120.
  4. DeFrances CJ, Lucas CA, Buie VC, Golosinskiy A. 2006 National hospital discharge survey. Natl Health Stat Report 2008:1-20.
  5. Labelle AJ, Arnold H, Reichley RM, Micek ST, Kollef MH. A comparison of culture-positive and culture-negative health-care-associated pneumonia. Chest 2010;137:1130-1137. https://doi.org/10.1378/chest.09-1652
  6. Tseng CC, Liu SF, Wang CC, et al. Impact of clinical severity index, infective pathogens, and initial empiric antibiotic use on hospital mortality in patients with ventilator-associated pneumonia. Am J Infect Control 2012;40:648-652. https://doi.org/10.1016/j.ajic.2011.08.017
  7. Depuydt PO, Vandijck DM, Bekaert MA, et al. Determinants and impact of multidrug antibiotic resistance in pathogens causing ventilator-associated-pneumonia. Crit Care 2008;12:R142. https://doi.org/10.1186/cc7119
  8. Depuydt P, Benoit D, Vogelaers D, et al. Outcome in bacteremia associated with nosocomial pneumonia and the impact of pathogen prediction by tracheal surveillance cultures. Intensive Care Med 2006;32:1773-1781. https://doi.org/10.1007/s00134-006-0354-8
  9. Eachempati SR, Hydo LJ, Shou J, Barie PS. Does de-escalation of antibiotic therapy for ventilator-associated pneumonia affect the likelihood of recurrent pneumonia or mortality in critically ill surgical patients? J Trauma 2009;66:1343-1348. https://doi.org/10.1097/TA.0b013e31819dca4e
  10. Park HK, Song JU, Um SW, et al. Clinical characteristics of health care-associated pneumonia in a Korean teaching hospital. Respir Med 2010;104:1729-1735. https://doi.org/10.1016/j.rmed.2010.06.009
  11. Mandell LA, Wunderink RG, Anzueto A, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis 2007;44 Suppl 2:S27-S72. https://doi.org/10.1086/511159
  12. American Thoracic Society; Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare- associated pneumonia. Am J Respir Crit Care Med 2005;171:388-416. https://doi.org/10.1164/rccm.200405-644ST
  13. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. Apache II: a severity of disease classification system. Crit Care Med 1985;13:818-829. https://doi.org/10.1097/00003246-198510000-00009
  14. Ferreira FL, Bota DP, Bross A, Melot C, Vincent JL. Serial evaluation of the SOFA score to predict outcome in critically ill patients. JAMA 2001;286:1754-1758. https://doi.org/10.1001/jama.286.14.1754
  15. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40:373-383. https://doi.org/10.1016/0021-9681(87)90171-8
  16. Fine MJ, Auble TE, Yealy DM, et al. A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med 1997;336:243-250. https://doi.org/10.1056/NEJM199701233360402
  17. Rello J, Lujan M, Gallego M, et al. Why mortality is increased in health-care-associated pneumonia: lessons from pneumococcal bacteremic pneumonia. Chest 2010;137:1138-1144. https://doi.org/10.1378/chest.09-2175
  18. Tejerina E, Frutos-Vivar F, Restrepo MI, et al. Prognosis factors and outcome of community-acquired pneumonia needing mechanical ventilation. J Crit Care 2005;20:230-238. https://doi.org/10.1016/j.jcrc.2005.05.010
  19. Diaz A, Alvarez M, Callejas C, Rosso R, Schnettler K, Saldias F. Clinical picture and prognostic factors for severe community-acquired pneumonia in adults admitted to the intensive care unit. Arch Bronconeumol 2005;41:20-26.
  20. Polverino E, Torres A, Menendez R, et al. Microbial aetiology of healthcare associated pneumonia in Spain: a prospective, multicentre, case-control study. Thorax 2013;68:1007-1014. https://doi.org/10.1136/thoraxjnl-2013-203828

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