OBJECTIVES: The impact of ICU-acquired pneumonia without etiologic diagnosis on patients' outcomes is largely unknown. We compared the clinical characteristics, inflammatory response, and outcomes between patients with and without microbiologically confirmed ICU-acquired pneumonia. DESIGN: Prospective observational study. SETTING: ICUs of a university teaching hospital. PATIENTS: We prospectively collected 270 consecutive patients with ICU-acquired pneumonia. Patients were clustered according to positive or negative microbiologic results. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We compared the characteristics and outcomes between both groups. Negative microbiology was found in 82 patients (30%). Both groups had similar baseline severity scores. Patients with negative microbiology presented more frequently chronic renal failure (15 [18%] vs 11 [6%]; p = 0.003), chronic heart disorders (35 [43%] vs 55 [29%]; p = 0.044), less frequently previous intubation (44 [54%] vs 135 [72%]; p = 0.006), more severe hypoxemia (PaO2/FIO2: 165 ± 73 mm Hg vs 199 ± 79 mm Hg; p = 0.001), and shorter ICU stay before the onset of pneumonia (5 ± 5 days vs 7 ± 9 days; p = 0.001) compared with patients with positive microbiology. The systemic inflammatory response was similar between both groups. Negative microbiology resulted in less changes of empiric treatment (33 [40%] vs 112 [60%]; p = 0.005) and shorter total duration of antimicrobials (13 ± 6 days vs 17 ± 12 days; p = 0.006) than positive microbiology. Following adjustment for potential confounders, patients with positive microbiology had higher hospital mortality (adjusted odds ratio 2.96, 95% confidence interval 1.24-7.04, p = 0.014) and lower 90-day survival (adjusted hazard ratio 0.50, 95% confidence interval 0.27-0.94, p = 0.031), with a nonsignificant lower 28-day survival. CONCLUSIONS: Although the possible influence of previous intubation in mortality of both groups is not completely discarded, negative microbiologic findings in clinically suspected ICU-acquired pneumonia are associated with less frequent previous intubation, shorter duration of antimicrobial treatment, and better survival. Future studies should corroborate the presence of pneumonia in patients with suspected ICU-acquired pneumonia and negative microbiology.

ICU-Acquired Pneumonia With or Without Etiologic Diagnosis: A Comparison of Outcomes / V. Giunta, M. Ferrer, M. Esperatti, O.T. Ranzani, L.M. Saucedo, G.L. Bassi, F. Blasi, A. Torres. - In: CRITICAL CARE MEDICINE. - ISSN 0090-3493. - 41:9(2013), pp. 2133-2143. [10.1097/CCM.0b013e31828a453b]

ICU-Acquired Pneumonia With or Without Etiologic Diagnosis: A Comparison of Outcomes

V. Giunta;F. Blasi;
2013

Abstract

OBJECTIVES: The impact of ICU-acquired pneumonia without etiologic diagnosis on patients' outcomes is largely unknown. We compared the clinical characteristics, inflammatory response, and outcomes between patients with and without microbiologically confirmed ICU-acquired pneumonia. DESIGN: Prospective observational study. SETTING: ICUs of a university teaching hospital. PATIENTS: We prospectively collected 270 consecutive patients with ICU-acquired pneumonia. Patients were clustered according to positive or negative microbiologic results. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We compared the characteristics and outcomes between both groups. Negative microbiology was found in 82 patients (30%). Both groups had similar baseline severity scores. Patients with negative microbiology presented more frequently chronic renal failure (15 [18%] vs 11 [6%]; p = 0.003), chronic heart disorders (35 [43%] vs 55 [29%]; p = 0.044), less frequently previous intubation (44 [54%] vs 135 [72%]; p = 0.006), more severe hypoxemia (PaO2/FIO2: 165 ± 73 mm Hg vs 199 ± 79 mm Hg; p = 0.001), and shorter ICU stay before the onset of pneumonia (5 ± 5 days vs 7 ± 9 days; p = 0.001) compared with patients with positive microbiology. The systemic inflammatory response was similar between both groups. Negative microbiology resulted in less changes of empiric treatment (33 [40%] vs 112 [60%]; p = 0.005) and shorter total duration of antimicrobials (13 ± 6 days vs 17 ± 12 days; p = 0.006) than positive microbiology. Following adjustment for potential confounders, patients with positive microbiology had higher hospital mortality (adjusted odds ratio 2.96, 95% confidence interval 1.24-7.04, p = 0.014) and lower 90-day survival (adjusted hazard ratio 0.50, 95% confidence interval 0.27-0.94, p = 0.031), with a nonsignificant lower 28-day survival. CONCLUSIONS: Although the possible influence of previous intubation in mortality of both groups is not completely discarded, negative microbiologic findings in clinically suspected ICU-acquired pneumonia are associated with less frequent previous intubation, shorter duration of antimicrobial treatment, and better survival. Future studies should corroborate the presence of pneumonia in patients with suspected ICU-acquired pneumonia and negative microbiology.
ICU; lung; microbiology; nosocomial infection; ventilator-associated pneumonia
Settore MED/10 - Malattie dell'Apparato Respiratorio
CRITICAL CARE MEDICINE
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/2434/224630
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