Original Research |

Decrease in Mortality in Severe Community-Acquired Pneumococcal Pneumonia: Impact of Improving Antibiotic Strategies (2000-2013)

Simone Gattarello; Bárbara Borgatta; Jordi Solé-Violán; Jordi Vallés; Loreto Vidaur; Rafael Zaragoza; Antoni Torres; Jordi Rello; CAPUCI II study investigators
Author and Funding Information

Vall d’Hebron Hospital, Critical Care Department, Universitat Autonoma de Barcelona and Medicine Department, Spain (Gattarello, Borgatta, Rello); CIBERES: Centro de Investigación en Red de Enfermedades Respiratorias (Solé-Violán, Vallés, Vidaur, Torres, Rello); Doctor Negrin Hospital, Las Palmas de Gran Canaria, Spain (Solé-Violán); Parc Tauli Hospital, Sabadell, Spain (Vallés); Donostia Hospital, Donostia, Spain (Vidaur); Dr Peset Hospital, Valencia, Spain (Zaragoza); Clinic Hospital, Barcelona, Spain. IDIBAPS. University of Barcelona (Torres)

Correspondence to: Simone Gattarello, MD, Critical Care Department, Vall d'Hebron University Hospital, Ps Vall d'Hebron, 119-129, Anexe AG - 5a planta, 08035 Barcelona, Spain; E-mail: gattarello@gmail.com

Financial support: 2001/SGR414, RED RESPIRA ISCIII (RTIC 03/11), FISS (PI 04/1500) and CIBERES (PCI Pneumonia). CAPUCI II is an ECCRN (European Critical Care Research Network) endorsed project by the ESICM (European Society of Intensive Care Medicine).

Chest. 2013. doi:10.1378/chest.13-1531
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OBJECTIVE:  To compare antibiotic prescribing practices and survival in the intensive care unit (ICU) in pneumococcal severe community-acquired pneumonia (SCAP) between 2000 and 2013.

MATERIALS AND METHODS:  Matched case-control study of two prospectively recorded cohorts in Europe. Eighty patients from CAPUCI II (cases) were matched with 80 patients from CAPUCI I (controls) based on: shock at admission, need of mechanical ventilation, COPD, immunosuppression and age.

RESULTS:  Demographic data were comparable in the two groups. Combined antibiotic therapy increased from 66.2% to 87.5% (p <0.01) and first dose of antibiotic was given within 3 hours from 27.5% to 70% (p <0.01). ICU mortality was significantly lower (OR 0.82, 95%CI 0.68-0.98) in cases, both in the whole population and in the subgroups of patients with shock (OR 0.67, 95%CI 0.50-0.89) or under mechanical ventilation (OR 0.73, 95%CI 0.55-0.96). In the multivariate analysis, ICU mortality increased in patients requiring mechanical ventilation (OR 5.23, 95%CI 1.60-17.17), and decreased in patients receiving early antibiotic treatment (OR 0.36, 95%CI 0.15-0.87) and combined therapy (OR 0.19, 95%CI 0.07-0.51).

CONCLUSIONS:  In pneumococcal SCAP, early antibiotic prescription and use of combination therapy increased; both were associated with improved survival.

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