SESSION TYPE: ICU Infections
PRESENTED ON: Wednesday, October 24, 2012 at 02:45 PM - 04:15 PM
PURPOSE: Severe pneumonia requiring ICU admission is associated with significant morbidity and mortality. This investigation seeks to determine the differences in microbial etiologies from the different pneumonia syndromes and their outcomes.
METHODS: The study population includes 1,356 medical ICU patients from an observational study from 2007 to 2008 that evaluated ICU staffing models at an urban academic community hospital. This database was screened for patients who met the diagnostic criteria for pneumonia, including clinical and laboratory data consistent with infection and demonstration of a pulmonary infiltrate on chest imaging. Pneumonia types were classified as community-acquired pneumonia (CAP), healthcare-associated pneumonia (HCAP) and hospital-acquired pneumonia (HAP) according to ATS definitions. Demographic data, comorbidities, microbial etiologies, mechanical ventilation requirements, APACHE II scores, length of stay and all-cause mortality were collected and analyzed.
RESULTS: In this ICU cohort, 181 patients (13.3%) met study criteria for pneumonia and 77 patients (42.5%) were classified as CAP, 85 patients (46.9%) as HCAP and 19 patients (10.4%) as HAP. Mechanical ventilation (MV) was required in 70 patients (38.6%), however, it was required by 47.4% of those with HAP. A microbial etiology was found in only 62 patients (34.2%). Gram positive pathogens were more frequent in CAP (11.7%), while gram negative organisms were preponderant in HCAP (16.4%). At ICU presentation, patients with HAP had the highest mean APACHE II scores at 25.1, followed by HCAP at 24.0, and CAP at 21.2. All-cause in-hospital mortality was 12.4%, with mortality rates of 9% for CAP, 16.4% for HCAP, and 10.5% for HAP.
CONCLUSIONS: Despite recent advances in antimicrobial therapy and supportive care, pneumonia syndromes still carry significantly high mortality risk and resource utilization. Patients with HCAP had high mortality rates, with Gram negative pathogens being the most common microbial etiology.
CLINICAL IMPLICATIONS: Our study helps in understanding the patterns of severe pneumonia syndromes admitted to an inner-city hospital ICU. This should help guide future management of these patients. The putative role of early, aggressive measures to unveil the microbial etiology of severe pneumonia needs to be further investigated.
DISCLOSURE: The following authors have nothing to disclose: Radu Neamu, Vern Kerchberger, Kristin Wise, Ketino Kobaidze, Kenneth Leeper
No Product/Research Disclosure InformationEmory University School of Medicine, Atlanta, GA