SEVERE COMMUNITY-ACQUIRED PNEUMONIA - ETIOLOGY, EPIDEMIOLOGY, AND PROGNOSIS FACTORS

A prospective study of 132 patients with severe community-acquired pne umonia (CAP) treated in the ICU was carried out to determine the causa tive agents, the value of the clinical, biological, and radiologic fea tures in predicting the etiology, and to define prognostic factors. Th e study group included 98 men and 34 women (mean age: 58 +/- 18 years) . The most frequent underlying condition was COPD (51 patients, 39 per cent). On admission, 35 patients were in shock, 71 were mentally confu sed, and 81 (61 percent) required mechanical ventilation during their hospitalization. The clinical, laboratory, and radiologic parameters w ere of little value for predicting the etiology in patients with sever e CAP. An etiologic diagnosis was made in 95 (72 percent) patients. Th e most frequent pathogens were Streptococcus pneumoniae (43 cases [45 percent]), Gram-negative bacilli (14 cases [15 percent]), and Haemophi lus influenzae (14 cases [15 percent]) Mortality was 24 percent. It wa s significantly associated with a age more than 60 years, septic shock , impairment of alertness, mechanical ventilation requirement, bactere mic pneumonia, and S pneumoniae or Enterobacteriaceae as the causes of the pneumonia. Recommendations for antibiotic chemotherapy in patient s with severe CAP admitted to the ICU are included.