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Epidemiology and outcome of severe pneumococcal pneumonia admitted to intensive care unit: a multicenter study.
Mongardon N., Max A., Bouglé A., Pène F., Lemiale V., Charpentier J., Cariou A., Chiche J.-D., Bedos J.-P., Mira J.-P.
Critical Care 16, 4 (2012) R155 - http://www.hal.inserm.fr/inserm-00756960
Epidemiology and outcome of severe pneumococcal pneumonia admitted to intensive care unit: a multicenter study.
Nicolas Mongardon1, Adeline Max1, Adrien Bouglé1, Frédéric Pène1, 2, Virginie Lemiale1, Julien Charpentier1, Alain Cariou1, Jean-Daniel Chiche1, 2, Jean-Pierre Bedos3, Jean-Paul Mira () 1, 2
1 :  Unité de Soins Intensifs [Cochin]
Hôpital Cochin – Assistance publique - Hôpitaux de Paris (AP-HP) – Université Paris V - Paris Descartes – PRES Sorbonne Paris Cité – Faculté de Médecine
27 rue du Faubourg Saint Jacques 75014 Paris, France
2 :  Institut Cochin
INSERM : U1016 – CNRS : UMR8104 – Université Paris V - Paris Descartes
22 rue Méchain, 75014 Paris
3 :  Unité de Soins Intensifs [Versailles]
Centre Hospitalier de Versailles (CHV)
177 rue de Versailles 78150 Le Chesnay
ABSTRACT: INTRODUCTION: Community-acquired pneumonia (CAP) account for a high proportion of ICU admissions, with Streptococcus pneumoniae being the main pathogen responsible for these infections. However, little is known on the clinical features and outcomes of ICU patients with pneumococcal pneumonia. The aims of this study were to provide epidemiological data and to determine risk factors of mortality in patients admitted to ICU for severe S. pneumoniae CAP. METHODS: We performed a retrospective review of two prospectively-acquired multicentre ICU databases (2001-2008). Patients admitted for management of severe pneumococcal CAP were enrolled if they met the 2001 American Thoracic Society criteria for severe pneumonia, had life-threatening organ failure and had a positive microbiological sample for S. pneumoniae. Patients with bronchitis, aspiration pneumonia or with non-pulmonary pneumococcal infections were excluded. RESULTS: Two hundred and twenty two patients were included, with a median SAPS 2 score reaching 47 [36-64]. Acute respiratory failure (n=154) and septic shock (n=54) were their most frequent causes of ICU admission. Septic shock occurred in 170 patients (77%) and mechanical ventilation was required in 186 patients (84%); renal replacement therapy was initiated in 70 patients (32%). Bacteremia was diagnosed in 101 patients. The prevalence of S. pneumoniae strains with decreased susceptibility to penicillin was 39.7%. Although antibiotherapy was adequate in 92.3% of cases, hospital mortality reached 28.8%. In multivariate analysis, independent risk factors for mortality were age [OR 1.05 (95% CI: 1.02-1.08)], male sex [OR 2.83 (95% CI: 1.16-6.91)] and renal replacement therapy [OR 3.78 (95% CI: 1.71-8.36)]. Co-morbidities, macrolide administration, concomitant bacteremia or penicillin susceptibility did not influence outcome. CONCLUSIONS: In ICU, mortality of pneumococcal CAP remains high despite adequate antimicrobial treatment. Baseline demographic data and renal replacement therapy have a major impact on adverse outcome.
Sciences du Vivant/Médecine humaine et pathologie/Physiologie

Articles dans des revues avec comité de lecture
Critical Care (Crit Care)
Publisher BioMed Central
ISSN 1364-8535 

Financial support was provided from the departmental association CARISMA (Cochin Association of Research on Inflammation Sepsis and Molecular Advances).
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