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The clinical features of severe community-acquired pneumonia presenting as septic shock. Norasept II Study Investigators.

Abstract：

PURPOSE:The purpose of this article was to determine the outcome, clinical and prognostic features, and microbiology of a large group of patients with community-acquired pneumonia (CAP) presenting in septic shock. MATERIALS AND METHODS:The placebo limb of the Norasept II database was examined. Data were collected on patients in septic shock with a diagnosis of CAP who presented to a participating site from home. RESULTS:One hundred and forty-eight patients met the study criteria. The 28-day survival was 53%. One hundred and four pathogens were isolated from 77 (52%) patients with 24 (16%) patients having polymicrobial infections. The most common pathogen was Streptococcus pneumoniae (19%), followed by Staphylococcus aureus (18%), Haemophilus influenzae (14%), Klebsiella pneumoniae (11%), and Pseudomonas aeruginosa (7%). Infection with P aeruginosa or Acinetobacter species carried a very high mortality (82%). The only clinical variables recorded in the database that could identify patients with pseudomonas or acinetobacter infection was a history of alcohol abuse. Comorbidities were present in 74% of patients, involving predominantly the cardiorespiratory system. Logistic regression analysis demonstrated APACHE II score and serum interleukin 6 (IL-6) concentration to be significant independent predictors of mortality. Patients with pseudomonas or acinetobacter infection had significantly higher IL-6 levels and significantly lower tumor necrosis factor alpha levels when compared with the rest of the cohort of patients. CONCLUSION:A diverse spectrum of both gram-positive and gram-negative pathogens were implicated in patients with CAP presenting in septic shock, necessitating broad spectrum empiric antimicrobial coverage. This coverage should include antipseudomonal activity, particularly in alcoholic patients. Severity of illness (APACHE II score) and IL-6 levels were important prognostic factors. Infection with P aeruginosa and Acinetobacter species carried a very high mortality.

journal_name

J Crit Care

journal_title

Journal of critical care

authors

Marik PE

doi

10.1053/jcrc.2000.16460

subject

Has Abstract

pub_date

2000-09-01 00:00:00

pages

85-90

issue

eissn

0883-9441

issn

1557-8615

pii

S088394410001858X

journal_volume

pub_type

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The clinical features of severe community-acquired pneumonia presenting as septic shock. Norasept II Study Investigators.