Research Article| Volume 86, ISSUE 1, P7-13, January 1992

The aetiology, management and outcome of severe community-acquired pneumonia on the intensive care unit

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      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.
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        • Woodhead MA
        • Macfarlane JT
        • McCracken JS
        • Rose DH
        • Finch RG
        Prospective study of the aetiology and outcome of pneumonia in the community.
        Lancet. 1987; i: 671-674
        • British Thoracic Society
        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
        • Marrie TJ
        • Durant H
        • Yates L
        Community-acquired pneumonia requiring hospitalisation: 5-year prospective study.
        Rev Infect Dis. 1989; 11: 586-599
        • White RJ
        • Blainey AD
        • Harrison KJ
        • Clarke SKR
        Causes of pneumonia presenting to a district general hospital.
        Thorax. 1981; 36: 566-570
        • Macfarlane JT
        • Ward MJ
        • Finch RG
        • Macrae AD
        Hospital study of adult community-acquired pneumonia.
        Lancet. 1982; ii: 255-258
        • McNabb WR
        • Williams TDM
        • Shanson DC
        • Lant AF
        Adult community-acquired pneumonia in central London.
        J R Soc Med. 1984; 77: 550-555
        • Berntsson E
        • Blomberg J
        • Lagergard T
        • Trollfors T
        Etiology of community-acquired pneumonia in patients requiring hospitalisation.
        Eur J Clin Microbiol. 1985; 4: 268-272
        • Holmberg H
        Aetiology of community-acquired pneumonia in hospital-treated patients.
        Scand J Infect Dis. 1987; 19: 491-501
        • Levy M
        • Dromer F
        • Brion N
        • Leturdu F
        • Carbon C
        Community-acquired pneumonia. Importance of initial noninvasive bacteriologic and radiographic investigations.
        Chest. 1988; 92: 43-48
        • Woodhead MA
        • Macfarlane JT
        • Rodgers FG
        • Laverick A
        • Pilkington R
        • Macrae AD
        Aetiology and outcome of severe community-acquired pneumonia.
        J Infect. 1985; 10: 204-210
        • Ortqvist A
        • Sterner G
        • Nilsson JA
        Severe community-acquired pneumonia: factors influencing need of intensive care treatment and prognosis.
        Scand J Infect Dis. 1985; 17: 377-386
        • Sorensen J
        • Cederholm I
        • Carlsson C
        Pneumonia: a deadly disease despite intensive care treatment.
        Scand J Infect Dis. 1986; 18: 329-335
        • Sorensen J
        • Forsberg P
        • Hakanson E
        • et al.
        A new diagnostic approach to the patient with severe pneumonia.
        Scand J Infect Dis. 1989; 21: 33-41
        • Alkhayer M
        • Jenkins PF
        • Harrison BDW
        The outcome of community-acquired pneumonia treated on the intensive care unit.
        Respir Med. 1990; 84: 13-16
        • Ruiz-Santana S
        • Jimenez AG
        • Esteban A
        • et al.
        ICU pneumonias; a multi-institutional study.
        Crit Care Med. 1987; 15: 930-932
        • Feldman C
        • Kallenbach JM
        • Levy H
        • et al.
        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
        • Pachon J
        • Prados MD
        • Capote F
        • Cuello JA
        • Garnacho J
        • Verano A
        Severe community-acquired pneumonia. Etiology, prognosis and treatment.
        AmRev Respir Dis. 1990; 142: 369-373
        • Stevens RM
        • Teres D
        • Skillman JJ
        • Feingold DS
        Pneumonia in an intensive care unit. A 30-month experience.
        Arch Intern Med. 1974; 134: 106-111
        • Thibault GE
        • Mulley AG
        • Barnett GO
        • et al.
        Medical intensive care: indications, interventions and outcome.
        N Engl J Med. 1980; 302: 938-942
        • Hook EW
        • Horton CA
        • Schaberg DR
        Failure of intensive care unit support to infuence mortality from pneumococcal bacteraemia.
        J Am Med Assoc. 1983; 249: 1055-1057
        • King Edward's Hospital Fund
        Intensive care services.
        Anaesthesia. 1989; 44: 428-431
      1. Epidemiological Program Office. Center for Disease Control, Atlanta GA 30333

        • Report from theh PHLS Communicable Disease Surveillance Centre
        BrMed J. 1987; 295: 1123-1125
        • Farr BM
        • Kaiser DL
        • Harrison BDW
        • Connolly CK
        Prediction of microbial aetiology at admission to hospital for pneumonia from the presenting clinical features.
        Thorax. 1989; 44: 1031-1035
        • Ortqvist A
        • Kalin M
        • Lejdeborn R
        • Lundberg B
        Diagnostic fibreoptic bronchoscopy and protected brush culture in patients with community-acquired pneumonia.
        Chest. 1990; 97: 576-582
        • Torres A
        • Jimenez P
        • Puig de la Bellacosa J
        • Celis R
        • Gonzalez J
        • Gea J
        Diagnostic value of non-fluoroscopic percutaneous needle aspiration in patients with pneumonia.
        Chest. 1990; 98: 840-844
        • Birtles RJ
        • Harrison TG
        • Samuel D
        • Taylor AG
        Evaluation of urinary antigen ELISA for diagnosing Legionella pneumophila serogroup 1 infection.
        J Clin Palhol. 1990; 43: 685-690
        • Purdie JAM
        • Ridley SA
        • Wallace PGM
        Effective use of regional intensive care units.
        BrMed J. 1990; 300: 79-81
        • van Eeden SF
        • Coetzee AR
        • Joubert JR
        Community-acquired pneumonia — factors influencing intensive care admission.
        S Afr Med J. 1988; 73: 77-81
        • Durocher A
        • Saulnier F
        • Beuscart R et al
        A comparison of three severity score indexes in an evaluation of serious bacterial pneumonia.
        Intens Care Med. 1988; 14: 39-43
        • Harrison BDW
        • Farr BM
        • Connolly CK
        • Macfarlane JT
        • Selkon JB
        • Bartlett CLR
        The hospital management of community-acquired pneumonia. Recommendations of the British Thoracic Society.
        J R Coll Phys. 1987; 21: 267-269
        • Powell M
        • Coutsia-Carouzou C
        • Voutsinas D
        • Seymour A
        • Williams JD
        Resistance of clinical isolates of Haemophilus influenzae in United Kingdom in 1986.
        BrMed J. 1987; 295: 176-179