Article (Scientific journals)
Host-pathogen interactions and prognosis of critically ill immunocompetent patients with pneumococcal pneumonia: the nationwide prospective observational STREPTOGENE study.
Bedos, Jean-Pierre; Varon, Emmanuelle; Porcher, Raphael et al.
2018In Intensive Care Medicine, 44 (12), p. 2162-2173
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Keywords :
Age Factors; Aged; Community-Acquired Infections; Critical Care; Critical Illness; Female; Hospital Mortality; Host-Pathogen Interactions; Humans; Logistic Models; Male; Middle Aged; Pneumonia, Pneumococcal/complications/mortality/therapy; Prognosis; Prospective Studies; Risk Factors; Sex Factors; Fluoroquinolones; Intensive care unit; Macrolides; Pneumococcal pneumonia; Pneumococcal serotypes; Severe community-acquired pneumonia
Abstract :
[en] PURPOSE: To assess the relative importance of host and bacterial factors associated with hospital mortality in patients admitted to the intensive care unit (ICU) for pneumococcal community-acquired pneumonia (PCAP). METHODS: Immunocompetent Caucasian ICU patients with PCAP documented by cultures and/or pneumococcal urinary antigen (UAg Sp) test were included in this multicenter prospective study between 2008 and 2012. All pneumococcal strains were serotyped. Logistic regression analyses were performed to identify risk factors for hospital mortality. RESULTS: Of the 614 patients, 278 (45%) had septic shock, 270 (44%) had bacteremia, 307 (50%) required mechanical ventilation at admission, and 161 (26%) had a diagnosis based only on the UAg Sp test. No strains were penicillin-resistant, but 23% had decreased susceptibility. Of the 36 serotypes identified, 7 accounted for 72% of the isolates, with different distributions according to age. Although antibiotics were consistently appropriate and were started within 6 h after admission in 454 (74%) patients, 116 (18.9%) patients died. Independent predictors of hospital mortality in the adjusted analysis were platelets </= 100 x 10(9)/L (OR, 7.7; 95% CI, 2.8-21.1), McCabe score >/= 2 (4.58; 1.61-13), age > 65 years (2.92; 1.49-5.74), lactates > 4 mmol/L (2.41; 1.27-4.56), male gender and septic shock (2.23; 1.30-3.83 for each), invasive mechanical ventilation (1.78; 1-3.19), and bilateral pneumonia (1.59; 1.02-2.47). Women with platelets </= 100 x 10(9)/L had the highest mortality risk (adjusted OR, 7.7; 2.8-21). CONCLUSIONS: In critically ill patients with PCAP, age, gender, and organ failures at ICU admission were more strongly associated with hospital mortality than were comorbidities. Neither pneumococcal serotype nor antibiotic regimen was associated with hospital mortality.
Disciplines :
Anesthesia & intensive care
Author, co-author :
Bedos, Jean-Pierre
Varon, Emmanuelle
Porcher, Raphael
Asfar, Pierre
Le Tulzo, Yves
Megarbane, Bruno
Mathonnet, Armelle
Dugard, Anthony
Veinstein, Anne
Ouchenir, Kader
Siami, Shidasp
Reignier, Jean
Galbois, Arnaud
Cousson, Joel
Preau, Sebastien
Baldesi, Olivier
Rigaud, Jean-Philippe
Souweine, Bertrand
Misset, Benoît ;  Université de Liège - CHU > Autres Services Médicaux > Service de Soins Intensifs
Jacobs, Frederic
Dewavrin, Florent
Mira, Jean-Paul
More authors (12 more) Less
Language :
English
Title :
Host-pathogen interactions and prognosis of critically ill immunocompetent patients with pneumococcal pneumonia: the nationwide prospective observational STREPTOGENE study.
Publication date :
2018
Journal title :
Intensive Care Medicine
ISSN :
0342-4642
eISSN :
1432-1238
Publisher :
Springer, Heidelberg, Germany
Volume :
44
Issue :
12
Pages :
2162-2173
Peer reviewed :
Peer Reviewed verified by ORBi
Available on ORBi :
since 10 December 2019

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