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Original Research: Chest Infections |

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

Simone Gattarello, MD; Bárbara Borgatta, MD; Jordi Solé-Violán, MD, PhD; Jordi Vallés, MD, PhD; Loreto Vidaur, MD; Rafael Zaragoza, MD, PhD; Antoni Torres, MD, PhD; Jordi Rello, MD, PhD; for the Community-Acquired Pneumonia en la Unidad de Cuidados Intensivos II Study Investigators∗
Author and Funding Information

From the Critical Care Department (Drs Gattarello, Borgatta and Rello), Vall d’Hebron Hospital, Universitat Autonoma de Barcelona and Medicine Department, Vall d’Hebron Institut de Recerca (VHIR), Barcelona; Intensive Care Unit (Dr Solé-Violán), Dr Negrin University Hospital, Las Palmas de Gran Canaria; Critical Care Center (Dr Vallés), Sabadell Hospital, Consorci Hospitalari Universitari Parc Taulí, Sabadell; Intensive Care Department (Dr Vidaur), Donostia Hospital, Donostia;. Intensive Care Department (Dr Zaragoza), Dr Peset University Hospital, Valencia; Respiratory Disease Department (Dr Torres), Hospital Clínic i Provincial de Barcelona, University of Barcelona, Institut d’investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona; and Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES) (Drs Solé-Violán, Vallés, Vidaur, Torres, and Rello), Bunyola, Islas Baleares, Spain.

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


*The investigators in the Community-Acquired Pneumonia en la Unidad de Cuidados Intensivos (CAPUCI) II study group are listed in e-Appendix 1.

FOR EDITORIAL COMMENT SEE PAGE 6

FUNDING/SUPPORT: This study received support from the following: 2001/SGR414, Red Respira Instituto de Salud Carlos III [RTIC 03/11], fondo de investigación sanitaria [PI 04/1500], and Centro de Investigación en Red de Enfermedades Respiratorias (proyecto corporativo de investigación Pneumonia).

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;146(1):22-31. doi:10.1378/chest.13-1531
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OBJECTIVE:  The objective of the present study was to compare antibiotic prescribing practices and survival in the ICU for patients with pneumococcal severe community-acquired pneumonia (SCAP) between 2000 and 2013.

METHODS:  This was a matched case-control study of two prospectively recorded cohorts in Europe. Eighty patients from the Community-Acquired Pneumonia en la Unidad de Cuidados Intensivos (CAPUCI) II study (case group) were matched with 80 patients from CAPUCI I (control group) based on the following: 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 < .01), and the percentage of patients receiving the first dose of antibiotic within 3 h increased from 27.5% to 70.0% (P < .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 receiving 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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