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Title: | Improvement of antibiotic therapy and ICU survival in severe non-pneumococcal community-acquired pneumonia: a matched case-control study |
Author: | Gattarello, Simone Lagunes, Leonel Vidaur, Loreto Solé Violán, Jordi Zaragoza, Rafael Vallés, Jordi Torres Martí, Antoni Sierra, Rafael Sebastian, Rosa Rello Condomines, Jordi |
Keywords: | Pneumònia Antibiòtics Unitats de cures intensives Estudi de casos Pneumonia Antibiotics Intensive care units Case studies |
Issue Date: | 10-Sep-2015 |
Publisher: | BioMed Central |
Abstract: | INTRODUCTION: We aimed to compare intensive care unit mortality due to non-pneumococcal severe community-acquired pneumonia between the periods 2000-2002 and 2008-2014, and the impact of the improvement in antibiotic strategies on outcomes. METHODS: This was a matched case-control study enrolling 144 patients with non-pneumococcal severe pneumonia: 72 patients from the 2000-2002 database (CAPUCI I group) were paired with 72 from the 2008-2014 period (CAPUCI II group), matched by the following variables: microorganism, shock at admission, invasive mechanical ventilation, immunocompromise, chronic obstructive pulmonary disease, and age over 65 years. RESULTS: The most frequent microorganism was methicillin-susceptible Staphylococcus aureus (22.1%) followed by Legionella pneumophila and Haemophilus influenzae (each 20.7%); prevalence of shock was 59.7%, while 73.6% of patients needed invasive mechanical ventilation. Intensive care unit mortality was significantly lower in the CAPUCI II group (34.7% versus 16.7%; odds ratio (OR) 0.78, 95% confidence interval (CI) 0.64-0.95; p = 0.02). Appropriate therapy according to microorganism was 91.5% in CAPUCI I and 92.7% in CAPUCI II, while combined therapy and early antibiotic treatment were significantly higher in CAPUCI II (76.4 versus 90.3% and 37.5 versus 63.9%; p < 0.05). In the multivariate analysis, combined antibiotic therapy (OR 0.23, 95% CI 0.07-0.74) and early antibiotic treatment (OR 0.07, 95% CI 0.02-0.22) were independently associated with decreased intensive care unit mortality. CONCLUSIONS: In non-pneumococcal severe community-acquired pneumonia , early antibiotic administration and use of combined antibiotic therapy were both associated with increased intensive care unit survival during the study period. |
Note: | Reproducció del document publicat a: http://dx.doi.org/10.1186/s13054-015-1051-1 |
It is part of: | Critical Care, 2015, vol. 19, p. 335 |
URI: | http://hdl.handle.net/2445/100405 |
Related resource: | http://dx.doi.org/10.1186/s13054-015-1051-1 |
ISSN: | 1364-8535 |
Appears in Collections: | Articles publicats en revistes (Medicina) |
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