A 5-YEAR STUDY OF SEVERE COMMUNITY-ACQUIRED PNEUMONIA WITH EMPHASIS ON PROGNOSIS IN PATIENTS ADMITTED TO AN INTENSIVE-CARE UNIT
A 5-YEAR STUDY OF SEVERE COMMUNITY-ACQUIRED PNEUMONIA WITH EMPHASIS ON PROGNOSIS IN PATIENTS ADMITTED TO AN INTENSIVE-CARE UNIT
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DOI：
10.1007/bf02425150
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发表时间：
1995-01-01
影响因子：
38.9
通讯作者：
BEAUCAIRE, G
中科院分区：
文献类型：
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作者：
LEROY, O;SANTRE, C;BEAUCAIRE, G
目的：描述重症监护病房患者严重社区获得性肺炎的流行病学特征并确定预后因素。设计：回顾性临床研究。地点：里尔大学医学院市总医院重症监护和传染病科。患者：连续 299 名表现出严重社区获得性肺炎的患者。测量和结果：入住 ICU 时，149 名患者因急性呼吸衰竭需要机械通气，其中 44 名患者出现急性呼吸衰竭。败血性休克。 71 名患者双侧肺部受累。 从 197 名患者 (65.9%) 中分离出 260 种微生物，最常见的是肺炎链球菌 (n = 80)、葡萄球菌。 (n = 57) 和革兰氏阴性杆菌 (n = 81)。 总死亡率为 28.5%（85 名患者）。 根据单变量分析，死亡率与年龄超过60岁、5年内预期死亡、免疫抑制、休克、机械通气、双侧肺部受累、菌血症、中性粒细胞计数<3500/mm3、血清总蛋白水平<45g/1、血清肌酐>15mg/1、非吸入性肺炎、初始治疗无效和并发症相关。 多变量分析仅选择了 5 个与预后显着相关的因素：5 年内预期死亡、休克、菌血症、非肺炎相关并发症和无效的初始治疗。结论：初始治疗的有效性似乎是最重要的预后因素，并且作为唯一且与初始医疗干预相关的因素，表明需要永久优化我们的抗菌策略。
Objectives: To characterize the epidemiology and to determine the prognosis factors in severe community-acquired pneumonia among patients admitted to an intensive care unit.Design: Retrospective clinical study.Setting: Intensive Care and Infectious Diseases Unit of a municipal general hospital of Lille University Medical School.Patients: 299 consecutive patients exhibiting severe community-acquired pneumonia.Measurements and results: On admission to ICU, 149 patients required mechanical ventilation for acute respiratory failure and 44 exhibited septic shock. Pulmonary involvement was bilateral in 71 patients. There were 260 organisms isolated from 197 patients (65.9%), the most frequent being Streptococcus pneumoniae (n = 80), Staphylococcus spp. (n = 57) and Gram-negative bacilli (n = 81). Overall mortality was 28.5% (85 patients). According to univariate analysis, mortality was associated with age over 60 years, anticipated death within 5 years, immunosuppression, shock, mechanical ventilation, bilateral pulmonary involvement, bacteremia, neutrophil count < 3500/mm3, total serum protein level < 45 g/1, serum creatinine > 15 mg/1, non-aspiration pneumonia, ineffective initial therapy and complications. Multivariate analysis selected only 5 factors significantly associated with prognosis: anticipated death within 5 years, shock, bacteremia, non-pneumonia-related complications and ineffective initial therapy.Conclusion: The effectiveness of the initial therapy appears to be the most significant prognosis factor and, as the one and only related to the initial medical intervention, suggests a need for permanent optimization of our antimicrobial strategies.