Tuberc Respir Dis.  2005 Nov;59(5):522-529.

The Etiologies and Initial Antimicrobial Therapy Outcomes in One Tertiary Hospital ICU-admitted Patient with Severe Community- acquired Pneumonia

• Lee JS
• Chung JW
• Koh Y
• Lim CM
• Jung YJ
• Oh YM
• Shim TS
• Lee SD
• Kim WS
• Kim DS
• Kim WD
• Hong SB

Abstract

BACKGROUND: Several national societies have published guidelines for empirical antimicrobial therapy in patients with severe community-acquired pneumonia (SCAP). This study investigated the etiologies of SCAP in the Asan Medical Center and assessed the relationship between the initial empirical antimicrobial regimen and 30 day mortality rate. METHOD: retrospective analysis was performed on patients with SCAP admitted to the ICU between March 2002 and February 2004 in the Asan Medical Center. The basic demographic data, bacteriologic study results and initial antimicrobial regimen were examined for all patients. The clinical outcomes including the ICU length of stay, the ICU mortality rate, and 30 days mortality rates were assessed by the initial antimicrobial regimen.
RESULTS
One hundred sixteen consecutive patients were admitted to the ICU (mean age 66.5 years, 81.9 % male, 30 days mortality 28.4 %). The microbiologic diagnosis was established in 58 patients (50 %). The most common pathogens were S. pneumoniae (n=12), P. aeruginosae (n=9), K. pneumonia (n=9) and S. aureus (n=8). The initial empirical antimicrobial regimens were classified as: beta-lactam plus macrolide; beta-lactam plus fluoroquinolone; anti-Pseudomonal beta-lactam plus fluoroquinolone; Aminoglycoside combination regimen; beta-lactam plus clindamycin; and beta-lactam alone. There were no statistical significant differences in the 30-day mortality rate according to the initial antimicrobial regimen (p = 0.682). Multivariate analysis revealed that acute renal failure, acute respiratory distress syndrome and K. pneumonae were independent risk factors related to the 30 day mortality rate.
CONCLUSION
S. pneumoniae, P. aeruginosae, K. pneumonia and S. aureus were the most common causative pathogens in patients with SCAP and K. pneumoniae was an independent risk factor for 30 day mortality. The initial antimicrobial regimen was not associated with the 30-day mortality.

Keyword

Severe community-acquired pneumonia; Etiology; Antimicrobial regimen; 30 days mortality

MeSH Terms

Acute Kidney Injury
Chungcheongnam-do
Clindamycin
Diagnosis
Humans
Length of Stay
Male
Mortality
Multivariate Analysis
Pneumonia*
Respiratory Distress Syndrome, Adult
Retrospective Studies
Risk Factors
Tertiary Care Centers*
Clindamycin