Am. J. Respir. Crit. Care Med., Volume 160, Number 3, September 1999, 923-929

Severe Community-acquired Pneumonia
Risk Factors and Follow-up Epidemiology

MAURICIO RUIZ, SANTIAGO EWIG, ANTONI TORRES, FRANCISCO ARANCIBIA, FRANCESC MARCO, JOSEP MENSA, MIGUEL SANCHEZ, and JOSE ANTONIO MARTINEZ

Servei de Pneumologia i Al·lèrgia Respiratòria, Servei de Microbiologia, Servei de Malalties Infeccioses, Servei de Urgències, Hospital Clínic i Provincial, Universitat de Barcelona, Barcelona, Spain

The aim of the study was to determine risk factors for severe community-acquired pneumonia (CAP) as well as to compare microbial patterns of severe CAP to a previous study from our respiratory intensive care unit (ICU) originating from 1984 to 1987. Patients admitted to the ICU according to clinical judgment were defined as having severe CAP. For the study of risk factors, a hospital-based case-control design was used, matching each patient with severe CAP to a patient hospitalized with CAP but not requiring ICU admission. Microbial investigation included noninvasive and invasive techniques. Overall, 89 patients with severe CAP were successfully matched to a control patient. The presence of an alcohol ingestion of  80 g/d (odds ratio [OR] 3.9, 95% confidence interval [CI] 1.4 to 10.6, p = 0.008) was found to be an independent risk factor for severe CAP and prior ambulatory antimicrobial treatment (OR 0.37, 95% CI 0.17 to 0.79, p = 0.009) to be protective. Streptococcus pneumoniae (24%) continued to be the most frequent pathogen; however, 48% of strains were drug-resistant. "Atypical" bacterial pathogens were significantly more common (17% versus 6%, p = 0.006) and Legionella spp. less common (2% versus 14%, p = 0.004) than in our previous study, whereas gram-negative enteric bacilli (GNEB) and Pseudomonas aeruginosa continued to represent important pathogens (6% and 5%, respectively). Our findings provide additional evidence for the importance of the initiation of early empiric antimicrobial treatment for a favorable outcome of CAP. Variations of microbial patterns are only in part due to different epidemiological settings. Therefore, initial empiric antimicrobial treatment will also have to take into account local trends of changing microbial patterns.

This article has been cited by other articles:

				M. I. Restrepo, E. M. Mortensen, J. A. Velez, C. Frei, and A. Anzueto A Comparative Study of Community-Acquired Pneumonia Patients Admitted to the Ward and the ICU Chest, March 1, 2008; 133(3): 610 - 617. [Abstract] [Full Text] [PDF]

				B. Schaaf, J. Kruse, J. Rupp, R. R. Reinert, D. Droemann, P. Zabel, S. Ewig, and K. Dalhoff Sepsis severity predicts outcome in community-acquired pneumococcal pneumonia Eur. Respir. J., September 1, 2007; 30(3): 517 - 524. [Abstract] [Full Text] [PDF]

				L. J. Quinton, M. R. Jones, B. T. Simms, M. S. Kogan, B. E. Robson, S. J. Skerrett, and J. P. Mizgerd Functions and Regulation of NF-{kappa}B RelA during Pneumococcal Pneumonia J. Immunol., February 1, 2007; 178(3): 1896 - 1903. [Abstract] [Full Text] [PDF]

				F. GOURIET, M. DRANCOURT, and D. RAOULT Multiplexed Serology in Atypical Bacterial Pneumonia Ann. N.Y. Acad. Sci., October 1, 2006; 1078(1): 530 - 540. [Abstract] [Full Text] [PDF]

				A. de Roux, M. Cavalcanti, M. A. Marcos, E. Garcia, S. Ewig, J. Mensa, and A. Torres Impact of Alcohol Abuse in the Etiology and Severity of Community-Acquired Pneumonia Chest, May 1, 2006; 129(5): 1219 - 1225. [Abstract] [Full Text] [PDF]

				A. de Roux, S. Ewig, E. Garcia, M. A. Marcos, J. Mensa, H. Lode, and A. Torres Mixed community-acquired pneumonia in hospitalised patients. Eur. Respir. J., April 1, 2006; 27(4): 795 - 800. [Abstract] [Full Text] [PDF]

				M. Masia, F. Gutierrez, C. Shum, S. Padilla, J. C. Navarro, E. Flores, and I. Hernandez Usefulness of Procalcitonin Levels in Community-Acquired Pneumonia According to the Patients Outcome Research Team Pneumonia Severity Index Chest, October 1, 2005; 128(4): 2223 - 2229. [Abstract] [Full Text] [PDF]

				A. Torres Monotherapy in Severe Community-Acquired Pneumonia: Is It Worthy? Chest, July 1, 2005; 128(1): 10 - 13. [Full Text] [PDF]

				N. A. Smyrnios, O. P. Schaefer, R. M. Collins, and J. M. Madison Applicability of Prediction Rules in Patients With Community-Acquired Pneumonia Requiring Intensive Care: A Pilot Study J Intensive Care Med, July 1, 2005; 20(4): 226 - 232. [Abstract] [PDF]

				O. Leroy, P. Saux, J.-P. Bedos, E. Caulin, and for the Levofloxacin Study Group Comparison of Levofloxacin and Cefotaxime Combined With Ofloxacin for ICU Patients With Community-Acquired Pneumonia Who Do Not Require Vasopressors Chest, July 1, 2005; 128(1): 172 - 183. [Abstract] [Full Text] [PDF]

				R. T. Sadikot, T. S. Blackwell, J. W. Christman, and A. S. Prince Pathogen-Host Interactions in Pseudomonas aeruginosa Pneumonia Am. J. Respir. Crit. Care Med., June 1, 2005; 171(11): 1209 - 1223. [Abstract] [Full Text] [PDF]

				F. Paganin, F. Lilienthal, A. Bourdin, N. Lugagne, F. Tixier, R. Genin, and J-L. Yvin Severe community-acquired pneumonia: assessment of microbial aetiology as mortality factor Eur. Respir. J., November 1, 2004; 24(5): 779 - 785. [Abstract] [Full Text] [PDF]

				A. de Roux, M. A. Marcos, E. Garcia, J. Mensa, S. Ewig, H. Lode, and A. Torres Viral Community-Acquired Pneumonia in Nonimmunocompromised Adults Chest, April 1, 2004; 125(4): 1343 - 1351. [Abstract] [Full Text] [PDF]

				O. Leroy, T. d'Escrivan, H. Georges, and S. Alfandari Impact of Positive Microbiological Diagnosis on Management and Prognosis of Severe Community-Acquired Pneumonia Chest, September 1, 2003; 124(3): 1179 - 1180. [Full Text]

				A. A. El-Solh, C. Pietrantoni, A. Bhat, A. T. Aquilina, M. Okada, V. Grover, and N. Gifford Microbiology of Severe Aspiration Pneumonia in Institutionalized Elderly Am. J. Respir. Crit. Care Med., June 15, 2003; 167(12): 1650 - 1654. [Abstract] [Full Text] [PDF]

				G. W. Waterer Combination Antibiotic Therapy With Macrolides in Community-Acquired Pneumonia: More Smoke But Is There Any Fire? Chest, May 1, 2003; 123(5): 1328 - 1329. [Full Text] [PDF]

				J. P. Mizgerd, M. L. Scott, M. R. Spieker, and C. M. Doerschuk Functions of I{kappa}B Proteins in Inflammatory Responses to Escherichia coli LPS in Mouse Lungs Am. J. Respir. Cell Mol. Biol., November 1, 2002; 27(5): 575 - 582. [Abstract] [Full Text] [PDF]

				F. Arancibia, T. T. Bauer, S. Ewig, J. Mensa, J. Gonzalez, M. S. Niederman, and A. Torres Community-Acquired Pneumonia Due to Gram-Negative Bacteria and Pseudomonas aeruginosa: Incidence, Risk, and Prognosis Arch Intern Med, September 9, 2002; 162(16): 1849 - 1858. [Abstract] [Full Text] [PDF]

				S. Ewig, M. Schlochtermeier, N. Goke, and M. S. Niederman Applying Sputum as a Diagnostic Tool in Pneumonia* : Limited Yield, Minimal Impact on Treatment Decisions Chest, May 1, 2002; 121(5): 1486 - 1492. [Abstract] [Full Text] [PDF]

				D. M. Musher, J. G. Bartlett, and G. V. Doern A Fresh Look at the Definition of Susceptibility of Streptococcus pneumoniae to {beta}-Lactam Antibiotics Arch Intern Med, November 26, 2001; 161(21): 2538 - 2544. [Abstract] [Full Text] [PDF]

				R. G. Wunderink and G. W. Waterer Severe Community-Acquired Pneumonia : The Need To Customize Empiric Therapy Chest, October 1, 2001; 120(4): 1053 - 1055. [Full Text] [PDF]

				M. S. Niederman, L. A. Mandell, A. Anzueto, J. B. Bass, W. A. Broughton, G. D. Campbell, N. Dean, T. File, M. J. Fine, P. A. Gross, et al. Guidelines for the Management of Adults with Community-acquired Pneumonia . Diagnosis, Assessment of Severity, Antimicrobial Therapy, and Prevention Am. J. Respir. Crit. Care Med., June 1, 2001; 163(7): 1730 - 1754. [Full Text] [PDF]

				W S Lim, J T Macfarlane, T C J Boswell, T G Harrison, D Rose, M Leinonen, and P Saikku Study of community acquired pneumonia aetiology (SCAPA) in adults admitted to hospital: implications for management guidelines Thorax, April 1, 2001; 56(4): 296 - 301. [Abstract] [Full Text]

				C. Alves, J.M. Nicolas, J.M. Miro, A. Torres, C. Agusti, J. Gonzalez, A. Rano, N. Benito, A. Moreno, F. Garcia, et al. Reappraisal of the aetiology and prognostic factors of severe acute respiratory failure in HIV patients Eur. Respir. J., January 1, 2001; 17(1): 87 - 93. [Abstract] [Full Text] [PDF]

				R. G. Wunderink and G. W. Waterer Appropriate Microbiological Testing in Community-Acquired Pneumonia Chest, January 1, 2001; 119(1): 5 - 7. [Full Text] [PDF]

				J C G Simpson, J T Macfarlane, J Watson, and M A Woodhead A national confidential enquiry into community acquired pneumonia deaths in young adults in England and Wales Thorax, December 1, 2000; 55(12): 1040 - 1045. [Abstract] [Full Text]