Abstract:
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.
journal_name
Chestjournal_title
Chestauthors
Gattarello S,Borgatta B,Solé-Violán J,Vallés J,Vidaur L,Zaragoza R,Torres A,Rello J,Community-Acquired Pneumonia en la Unidad de Cuidados Intensivos II Study Investigators*.doi
10.1378/chest.13-1531subject
Has Abstractpub_date
2014-07-01 00:00:00pages
22-31issue
1eissn
0012-3692issn
1931-3543pii
S0012-3692(15)48744-6journal_volume
146pub_type
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