Severe community-acquired pneumonia in intensive care. 2020

H Bartoš, and O Džupová

OBJECTIVE To describe the characteristics of patients with severe pneumonia treated in Czech intensive care units (ICU) and to compare this study group with the available European and world literature data. METHODS The prospective observational study launched on 1 September 2017 includes adult patients with community-acquired pneumonia from three Czech ICUs. It focuses on demographic data, chronic comorbidity, clinical and laboratory parameters, X-ray findings, microbiological findings, therapeutic procedures, and treatment outcomes.  Results: As of 31 May 2019, 74 patients, 21 females and 53 males, were included in the study. Fifty-three (71.6%) patients had an underlying chronic disease. Only one patient was vaccinated against influenza and pneumococcal infections. The main symptoms were cough and dyspnea, in 63 (85.1%) patients, pathology on auscultation, in 64 (86.5%) patients, and fever, in 23 (31.1%) patients. Bilateral pathology on X-ray was observed in 34 (45.9%) patients. The most commonly detected pathogens were Streptococcus pneumoniae, in 22 (29.7%) patients, and influenza virus, in 16 (21.6%) patients. The etiology was not established in 23 (31.1%) patients. Third-generation cephalosporins and potentiated aminopenicillin as the most common initial empirical therapies were used in 39 (52.7%) and 20 (27%) patients, respectively. The initial therapy turned out to be effective in 59 (79.7%) patients. Forty-six (62.2%) patients required mechanical ventilation, 40 (54.1%) patients required vasopressors, and 10 (13.5%) patients required the use of renal replacement therapy. The average length of ICU stay was 15.5 days. Forty-seven (63.5%) patients were discharged home, 17 (23%) patients were transferred to long-term care facilities, and 10 (13.5%) patients died. CONCLUSIONS The study presents the first results characterizing patients with severe community-acquired pneumonia in the Czech Republic. For most indicators, the characteristics of the Czech patients are comparable with the data from other countries, but differences were found in the pneumococcal and influenza vaccine coverage rates, which were low in the Czech Republic. Despite the appropriate empirical antibiotic therapies, severe pneumonia was associated with high mortality and prolonged morbidity.

UI MeSH Term Description Entries
D007362 Intensive Care Units Hospital units providing continuous surveillance and care to acutely ill patients. ICU Intensive Care Units,Intensive Care Unit,Unit, Intensive Care
D008297 Male Males
D011014 Pneumonia Infection of the lung often accompanied by inflammation. Experimental Lung Inflammation,Lobar Pneumonia,Lung Inflammation,Pneumonia, Lobar,Pneumonitis,Pulmonary Inflammation,Experimental Lung Inflammations,Inflammation, Experimental Lung,Inflammation, Lung,Inflammation, Pulmonary,Inflammations, Lung,Inflammations, Pulmonary,Lobar Pneumonias,Lung Inflammation, Experimental,Lung Inflammations,Lung Inflammations, Experimental,Pneumonias,Pneumonias, Lobar,Pneumonitides,Pulmonary Inflammations
D011446 Prospective Studies Observation of a population for a sufficient number of persons over a sufficient number of years to generate incidence or mortality rates subsequent to the selection of the study group. Prospective Study,Studies, Prospective,Study, Prospective
D003422 Critical Care Health care provided to a critically ill patient during a medical emergency or crisis. Intensive Care,Intensive Care, Surgical,Surgical Intensive Care,Care, Critical,Care, Intensive,Care, Surgical Intensive
D005260 Female Females
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D017714 Community-Acquired Infections Any infection acquired in the community, that is, contrasted with those acquired in a health care facility (CROSS INFECTION). An infection would be classified as community-acquired if the patient had not recently been in a health care facility or been in contact with someone who had been recently in a health care facility. Community Acquired Infection,Community-Acquired Infection,Infections, Community-Acquired,Acquired Infection, Community,Acquired Infections, Community,Community Acquired Infections,Infection, Community Acquired,Infection, Community-Acquired,Infections, Community Acquired
D018153 Czech Republic Created 1 January 1993 as a result of the division of Czechoslovakia into the Czech Republic and Slovakia.

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