Improved survival among ICU hospitalized patients with community-acquired pneumonia by unidentified organisms. A multicentre case-control study
CCCF ePoster library. Gattarello S. Nov 2, 2016; 151015; 133 Disclosure(s): No financial disclosures to report.
Simone Gattarello
Simone Gattarello
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Topic: Retrospective or Prospective Cohort Study

Improved survival among ICU hospitalized patients with community-acquired pneumonia by unidentified organisms. A multicentre case-control study


Rello Jordi 1,2; Diaz Emili 2,3; Mañez Rafael 4; Sole-Violan Jordi 2,5; Valles Jordi 2,5; Vidaur Loreto 2,7; Zaragoza Rafael 8; Gattarello Simone 1; and CAPUCI2 Consortium.

1- Universitat Autonoma de Barcelona, Barcelona, Spain,
2- CIBERES, Barcelona,
3- Intensive Care Unit, Hospital Joan XXIII, Tarragona, Spain,
4- Intensive Care Unit, Hospital de Bellvitge, Barcelona, Spain,
5- Intensive Care Unit, Hospital Negrin, Las Palmas de Gran Canaria, Spain,
6- Intensive Care Unit, Hospital Parc Tauli, Sabadell, Spain,
7- Intensive Care Unit, Hospital de Donostia, Donostia, Spain,
8- Intensive Care Unit, Hospital Peset, Valencia, Spain.



Abstract:

A retrospective analysis from prospectively collected data was conducted in 33 hospitals in Europe. The primary objective was to compare the trend in Intensive Care Unit (ICU) survival among adults with severe community-acquired pneumonia (CAP) due to unknown organisms from 2000 to 2015. The secondary objective was to establish whether changes in antibiotic policies were associated with different outcomes. ICU mortality decreased (p = 0.02) from 26.9% in the first study period (2000-2002) to 15.7% in the second period (2008-2015). Demographic data and clinical severity at admission were comparable between groups, except for age over 65 and incidence of cardiomyopathy. Over time, patients received higher rates of combination therapy (94.3% vs. 77.2%; p < 0.01) and early (<3h) antibiotic delivery (72.9% vs. 50.3%; p < 0.01); likewise, the 2008-2015 group was more likely to receive adequate antibiotic prescription (as defined by the Infectious Disease Society of America/American Thoracic Society (IDSA/ATS) guidelines) than  the 2000-2002 group (70.7% vs. 48.2%; p < 0.01). Multivariate analysis showed an independent association between decreased ICU mortality and early (<3h) antibiotic administration (OR 3.48 [1.70-7.15], p < 0.01) or adequate antibiotic prescription according to guidelines (OR 2.22 [1.11-4.43], p = 0.02). In conclusion, our findings suggest that ICU mortality in severe CAP due to unidentified organisms has decreased in the last 15 years. Several changes in management and better compliance with guidelines over time were associated with increased survival.


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