Elsevier

Respiratory Medicine

Volume 86, Issue 1, January 1992, Pages 7-13
Respiratory Medicine

The aetiology, management and outcome of severe community-acquired pneumonia on the intensive care unit

https://doi.org/10.1016/S0954-6111(06)80141-1Get rights and content

In a retrospective study of adults with severe community-acquired pneumonia (SCAP) admitted to the intensive care unit, 60 patients were identified from 25 hospitals within the 12-month study period. Thirty- two percent were aged < 44 years and 65% <65. One-third were previously fit. Two or more of the following three features, respiratory rate ≥30min−1, diastolic blood pressure ≤60mmHg and bloodurea >7mmol 1−1, were present in 72%.

A pathogen was identified in 58% and five pathogens, Streptococcus pneumoniae, Haemophilus influenzae, Legionella pneumophila, Mycoplasma pneumoniae and Staphylococcus aureus accounted for 86% of these. Gram-negative enterobacteria were identified only once.

Forty-eight percent reached the intensive care unit within 24 h of hospital admission, with respiratory failure or progressive exhaustion beingthe main reason for transfer. However, eight patients were only transferred following a cardio-respiratory arrest on the general ward. Eighty-eight percent received assisted ventilation which was given for a median of 8 days. A median of 4 (range 1–11) different antibiotics were given to each patient, with erythromycin and the penicillins prescribed most frequently. Aminoglycosides were given to 43% of patients, although Gram-negative enterobacteria were rarely found. Forty-eight percent died during the acute illness and a further 5% died shortly afterwards. Multi-organ failure was common with respiratory failure alone accounting for a minority of deaths. Forty-eight percent of deaths occurred within 1 week of hospital admission, but of 18 patients stillreceiving assisted ventilation at 14 days, 67% survived. No individual clinical or laboratory feature on admission was significantly associated with death. Only 27% of the total made a complete recovery.

Based on the organisms identified in this study initial empirical antibiotic therapy in severely ill patients with community-acquired pneumonia should cover S. pneumoniae, H. influenzae, L. pneumophila, M. pneumoniae and Staph. aureus.

References (32)

  • McNabbWR et al.

    Adult community-acquired pneumonia in central London

    J R Soc Med

    (1984)
  • BerntssonE et al.

    Etiology of community-acquired pneumonia in patients requiring hospitalisation

    Eur J Clin Microbiol

    (1985)
  • HolmbergH

    Aetiology of community-acquired pneumonia in hospital-treated patients

    Scand J Infect Dis

    (1987)
  • OrtqvistA et al.

    Severe community-acquired pneumonia: factors influencing need of intensive care treatment and prognosis

    Scand J Infect Dis

    (1985)
  • SorensenJ et al.

    Pneumonia: a deadly disease despite intensive care treatment

    Scand J Infect Dis

    (1986)
  • SorensenJ et al.

    A new diagnostic approach to the patient with severe pneumonia

    Scand J Infect Dis

    (1989)
  • Cited by (133)

    • Decreased serum level of lipoprotein cholesterol is a poor prognostic factor for patients with severe community-acquired pneumonia that required intensive care unit admission

      2015, Journal of Critical Care
      Citation Excerpt :

      Severe community-acquired pneumonia (CAP) is now recognized as an entity of its own requiring a specific management approach [1-8].

    • Defining severe pneumonia

      2011, Clinics in Chest Medicine
    • Predictors of failure of noninvasive ventilation in patients with severe community-acquired pneumonia

      2010, Journal of Critical Care
      Citation Excerpt :

      A percentage ranging from 60% to 90% of patients with CAP develop acute respiratory failure (ARF) and require intubation and mechanical ventilation (MV) as a life-support treatment, whereas appropriate antibiotic therapy is being established. A number of studies, however, indicate that invasive MV is associated with high rates of serious complications and mortality [2-4]. Noninvasive ventilation (NIV) refers to the delivery of assisted MV without an invasive airway conduit.

    • Clinical and economic burden of community-acquired pneumonia among adults in Europe

      2012, Thorax
      Citation Excerpt :

      Although several outpatient and inpatient studies were conducted in different regions in Spain, no conclusions can be drawn about regional differences in incidence within a country because the studies were conducted during different time periods and may have had different designs. Table 53–5 8 9 12–14 18 21 22 24 35 37–39 42–44 46 49 50 58 59 61–64 66 67 69–71 73 75 77–87 summarises mortality studies in patients with CAP. Mortality varied from <1% to 48% and was not related to antibiotic resistance.

    View all citing articles on Scopus

    This study was organized by a subcommittee of the Research Committee of the British Thoracic Society and the Public Health Laboratory Service whose members were: Dr C. L. R.Bartlett, Dr B. D. W. Harrison, Dr J.T. Macfarlane, Dr J. B. Selkon, Dr J. Watson, Dr J. H. Winter and Dr M.A. Woodhead.The study was coordinated and the data analysed by Miss J. White and Miss J. Bruce underthe direction of Dr M. A. Woodhead who prepared the report

    View full text