This paper is only available as a PDF. To read, Please Download here.
In a retrospective study of adults with severe community-acquired pneumonia (SCAP)
admitted to the intensive care unit, 60 patients were identified from 25 hospitals
within the 12-month study period. Thirty- two percent were aged < 44 years and 65%
<65. One-third were previously fit. Two or more of the following three features, respiratory
rate ≥30min−1, diastolic blood pressure ≤60mmHg and bloodurea >7mmol 1−1, were present in 72%.
A pathogen was identified in 58% and five pathogens, Streptococcus pneumoniae, Haemophilus influenzae, Legionella pneumophila, Mycoplasma
pneumoniae and Staphylococcus aureus accounted for 86% of these. Gram-negative enterobacteria were identified only once.
Forty-eight percent reached the intensive care unit within 24 h of hospital admission,
with respiratory failure or progressive exhaustion beingthe main reason for transfer.
However, eight patients were only transferred following a cardio-respiratory arrest
on the general ward. Eighty-eight percent received assisted ventilation which was
given for a median of 8 days. A median of 4 (range 1–11) different antibiotics were
given to each patient, with erythromycin and the penicillins prescribed most frequently.
Aminoglycosides were given to 43% of patients, although Gram-negative enterobacteria
were rarely found. Forty-eight percent died during the acute illness and a further
5% died shortly afterwards. Multi-organ failure was common with respiratory failure
alone accounting for a minority of deaths. Forty-eight percent of deaths occurred
within 1 week of hospital admission, but of 18 patients stillreceiving assisted ventilation
at 14 days, 67% survived. No individual clinical or laboratory feature on admission
was significantly associated with death. Only 27% of the total made a complete recovery.
Based on the organisms identified in this study initial empirical antibiotic therapy
in severely ill patients with community-acquired pneumonia should cover S. pneumoniae, H. influenzae, L. pneumophila, M. pneumoniae and Staph. aureus.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Respiratory MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Prospective study of the aetiology and outcome of pneumonia in the community.Lancet. 1987; i: 671-674
- Community-acquired pneumonia in adults in British hospitals in 1982 –1983: a BTS/ PHLS survey of aetiology, mortality, prognostic factors and outcome.Quart J Med. 1987; 62: 195-220
- Community-acquired pneumonia requiring hospitalisation: 5-year prospective study.Rev Infect Dis. 1989; 11: 586-599
- Causes of pneumonia presenting to a district general hospital.Thorax. 1981; 36: 566-570
- Hospital study of adult community-acquired pneumonia.Lancet. 1982; ii: 255-258
- Adult community-acquired pneumonia in central London.J R Soc Med. 1984; 77: 550-555
- Etiology of community-acquired pneumonia in patients requiring hospitalisation.Eur J Clin Microbiol. 1985; 4: 268-272
- Aetiology of community-acquired pneumonia in hospital-treated patients.Scand J Infect Dis. 1987; 19: 491-501
- Community-acquired pneumonia. Importance of initial noninvasive bacteriologic and radiographic investigations.Chest. 1988; 92: 43-48
- Aetiology and outcome of severe community-acquired pneumonia.J Infect. 1985; 10: 204-210
- Severe community-acquired pneumonia: factors influencing need of intensive care treatment and prognosis.Scand J Infect Dis. 1985; 17: 377-386
- Pneumonia: a deadly disease despite intensive care treatment.Scand J Infect Dis. 1986; 18: 329-335
- A new diagnostic approach to the patient with severe pneumonia.Scand J Infect Dis. 1989; 21: 33-41
- The outcome of community-acquired pneumonia treated on the intensive care unit.Respir Med. 1990; 84: 13-16
- ICU pneumonias; a multi-institutional study.Crit Care Med. 1987; 15: 930-932
- Community-acquired pneumonia of diverse aetiology: prognostic features in patients admitted to an intensive care unit and a ‘severity of illness’ score.Intens Care Med. 1989; 15: 302-307
- Severe community-acquired pneumonia. Etiology, prognosis and treatment.AmRev Respir Dis. 1990; 142: 369-373
- Pneumonia in an intensive care unit. A 30-month experience.Arch Intern Med. 1974; 134: 106-111
- Medical intensive care: indications, interventions and outcome.N Engl J Med. 1980; 302: 938-942
- Failure of intensive care unit support to infuence mortality from pneumococcal bacteraemia.J Am Med Assoc. 1983; 249: 1055-1057
- Intensive care services.Anaesthesia. 1989; 44: 428-431
Epidemiological Program Office. Center for Disease Control, Atlanta GA 30333
- BrMed J. 1987; 295: 1123-1125
- Prediction of microbial aetiology at admission to hospital for pneumonia from the presenting clinical features.Thorax. 1989; 44: 1031-1035
- Diagnostic fibreoptic bronchoscopy and protected brush culture in patients with community-acquired pneumonia.Chest. 1990; 97: 576-582
- Diagnostic value of non-fluoroscopic percutaneous needle aspiration in patients with pneumonia.Chest. 1990; 98: 840-844
- Evaluation of urinary antigen ELISA for diagnosing Legionella pneumophila serogroup 1 infection.J Clin Palhol. 1990; 43: 685-690
- Effective use of regional intensive care units.BrMed J. 1990; 300: 79-81
- Community-acquired pneumonia — factors influencing intensive care admission.S Afr Med J. 1988; 73: 77-81
- A comparison of three severity score indexes in an evaluation of serious bacterial pneumonia.Intens Care Med. 1988; 14: 39-43
- The hospital management of community-acquired pneumonia. Recommendations of the British Thoracic Society.J R Coll Phys. 1987; 21: 267-269
- Resistance of clinical isolates of Haemophilus influenzae in United Kingdom in 1986.BrMed J. 1987; 295: 176-179
Article info
Publication history
Received in revised form:
September 17,
1991
Received:
May 22,
1991
Footnotes
This study was organized by a subcommittee of the Research Committee of the British Thoracic Society and the Public Health Laboratory Service whose members were: Dr C. L. R.Bartlett, Dr B. D. W. Harrison, Dr J.T. Macfarlane, Dr J. B. Selkon, Dr J. Watson, Dr J. H. Winter and Dr M.A. Woodhead.The study was coordinated and the data analysed by Miss J. White and Miss J. Bruce underthe direction of Dr M. A. Woodhead who prepared the report
Identification
Copyright
© 1992 Baillière Tindall All rights reserved. Published by Elsevier Inc.
