Abstract

SABATIER, C. et al. Community-acquired pneumonia: A 7-years descriptive study. Usefulness of the IDSA/ATS 2007 in the assessment of ICU admission. Med. Intensiva [online]. 2010, vol.34, n.4, pp.237-245. ISSN 0210-5691.

Objective: To describe the clinical characteristics and outcomes of patients with community-acquired pneumonia (CAP) admitted to the Intensive Care Unit (ICU). To evaluate new ATS/IDSA criteria to identify patients with CAP who required admission to ICU. Design: Retrospective analysis of prospective collected data in a 7-year period (2000-2007). Setting: Medical-surgical ICU with 16 beds. Patients: All patients with severe CAP admitted to the ICU (n=147). Primary endpoints: Clinical and microbiological characteristics. Prognostic factors. Comparison of patients admitted in the ICU and ATS/IDSA criteria (group 1: >1 major criterion, group 2: >3 minor criteria and group 3: no criterion). Intervention: None. Results: Admission to the ICU is required for patients with acute respiratory failure (60.5%) and with septic shock (28.5%). A total of 71.4%, had an identifiable microbial etiology, S. pneumoniae being the most frequently isolated. Mean time to antibiotic therapy was 4.3±4.2h, this being adequate in 97.1%. ICU global mortality rate was 32%. Prognostic factors associated with higher mortality were acute renal failure (OR:4.7), mechanical ventilation (OR:3.4), non-identifiable etiology (OR:4.2) and non-S. pneumonia etiology (OR:3.5). Sixty-eight percent of the patients were included in the first group of the ATS/IDSA criteria and 21% in the second group. Conclusions: CAP mortality is still high despite early antibiotic therapy, especially in those patients with a non-S. pneumonia etiology or who require mechanical ventilation. Almost 90% of the ICU admissions were identified by the new criteria from ATS/IDSA.

Keywords : Community-acquired pneumonia; Intensive care unit; Prognostic factors.

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