Severe Community-acquired Pneumonia risk community and follow-up epidemiology.pdfVIP

Am J Respir Crit Care Med Vol 160. pp 923–929, 1999 Internet address: Severe Community-acquired Pneumonia Risk Factors and Follow-up Epidemiology MAURICIO RUIZ, SANTIAGO EWIG, ANTONI TORRES, FRANCISCO ARANCIBIA, FRANCESC MARCO, JOSEP MENSA, MIGUEL SANCHEZ, and JOSE ANTONIO MARTINEZ Servei de Pneumologia i Al ? lèrgia Respiratòria, Servei de Microbiologia, Servei de Malalties Infeccioses, Servei de Urgències, Hospital Clínic i Provincial, Universitat de Barcelona, Barcelona, Spain The aim of the study was to determine risk factors for severe community-acquired pneumonia (CAP) as well as to compare microbial patterns of severe CAP to a previous study from our respiratory inten- sive care unit (ICU) originating from 1984 to 1987. Patients admitted to the ICU according to clinical judgment were defined as having severe CAP. For the study of risk factors, a hospital-based case-con- trol design was used, matching each patient with severe CAP to a patient hospitalized with CAP but not requiring ICU admission. Microbial investigation included noninvasive and invasive techniques. Overall, 89 patients with severe CAP were successfully matched to a control patient. The presence of an alcohol ingestion of 80 g/d (odds ratio [OR] 3.9, 95% confidence interval [CI] 1.4 to 10.6, p 5 0.008) was found to be an independent risk factor for severe CAP and prior ambulatory antimicrobial treatment (OR 0.37, 95% CI 0.17 to 0.79, p 5 0.009) to be protective. Streptococcus pneumoniae (24%) continued to be the most frequent pathogen; however, 48% of strains were drug-resistant. “Atypical” bacterial pathogens were significantly more common (17% versus 6%, p 5 0.006) and Le- gionella spp. less common (2% versus 14%, p 5 0.004) than in our previous study, whereas gram- negative enteric bacilli (GNEB) and Pseudomonas aeruginosa continued to represent important patho- gens (6% and 5%, respectively). Our findings provide additional evid