Community acquired polymicrobial pneumonia in the intensive care unit: aetiology and prognosis.
Cilloniz C, Ewig S, Ferrer M, Polverino E, Gabarrus A, Puig de la Bellacasa J, Mensa J, Torres A.
Crit Care. 2011 Sep 14;15(5):R209. [Epub ahead of print]
Abstract
INTRODUCTION: The frequency and clinical significance of polymicrobial aetiology in community-acquired pneumonia (CAP) patients admitted to intensive care unit (ICU) has been poorly studied. The aim of this study was to describe the prevalence, clinical characteristics and outcomes of severe CAP of polymicrobial aetiology in patients admitted to the ICU.
METHODS: Prospective observational study, we included 362 consecutive adult patients with CAP admitted to the ICU within 24 hours of presentation; 196 (54%) had an aetiology established. RESULTS: Polymicrobial infection was present in 39 (11%) cases (20% of those with defined aetiology): 33 cases with 2 pathogens and 6 with 3 pathogens. The most frequently identified pathogens in polymicrobial infections were Streptococcus pneumoniae (n=28, 72%), respiratory viruses (n=15, 39%) and Pseudomonas aeruginosa (n=8, 21%). Chronic respiratory disease and acute respiratory distress syndrome criteria were independent predictors of polymicrobial aetiology. Inappropriate initial antimicrobial treatment was more frequent in the polymicrobial, compared with the monomicrobial aetiology group (39% versus 10%, p <0.001), and was an independent predictor of hospital mortality (adjusted odds-ratio 10.79, 95% confidence interval 3.97 to 29.30; p<0.001). However, the trend for higher hospital mortality of polymicrobial, compared with monomicrobial aetiology group (8, 21% versus 17, 11%) was not significantly different (p=0.10). CONCLUSIONS: Polymicrobial pneumonia occurs frequently in patients admitted to the ICU. This is a risk factor for inappropriate initial antimicrobial treatment which in turn independently predicts hospital mortality.
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