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
Disclosure(s): No financial disclosures to report.
Simone Gattarello
Simone Gattarello
Login now to access Regular content available to all registered users.

You may also access this content "anytime, anywhere" with the Free MULTILEARNING App for iOS and Android
Rate & Comment (0)

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.


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.


1) Dombrovskiy VY, Martin AA, Sunderram J, Paz HL. Rapid increase in hospitalization and mortality rates for severe sepsis in the United States: A trend analysis from 1993 to 2003. Crit Care Med 2007;35:1244-1250.

2) Spoorenberg SM, Bos WJ, Heijligenberg R, Voorn PG, Grutters JC, Rijkers GT, van de Garde EM. Microbial aetiology, outcomes and costs of hospitalisation for community-acquired pneumonia; an observational analysis. BMC Infect Dis 2014;14:335.

3) Rhodes A, Phillips G, Beale R, Cecconi M, Chiche JD, De Backer D, Divatia J, Du B, Evans L, Ferrer R, Girardis M, Koulenti D, Machado F, Simpson SQ, Tan CC, Wittebole X, Levy M. The Surviving Sepsis Campaign bundles and outcome: results from the International Multicentre Prevalence Study on Sepsis. Intensive Care Med 2015;41:1620-1628.

4) Martin-Loeches I, Lisboa T, Rodriguez A, Putensen C, Annane D, Garnacho-Montero J, Restrepo MI, Rello J. Combination antibiotic therapy with macrolides improves survival in intubated patients with community-acquired pneumonia. Intensive Care Med 2010;36:612-620.

5) Gattarello S. What Is New in Antibiotic Therapy in Community-Acquired Pneumonia? An Evidence-Based Approach Focusing on Combined Therapy. Curr Infect Dis Rep 2015;17:501.

6) McIntosh KA, Maxwell DJ, Pulver LK, Horn F, Robertson MB, Kaye KI, Peterson GM, Dollman WB, Wai A, Tett SE. A quality improvement initiative to improve adherence to national guidelines for empiric management of community-acquired pneumonia in emergency departments. Int J Qual Health Care 2011;23:142-150.

7) Bodí M, Rodríguez A, Solé-Violán J, Gilavert MC, Garnacho J, Blanquer J, Jimenez J, de la Torre MV, Sirvent JM, Almirall J, Doblas A, Badía JR, García F, Mendia A, Jordá R, Bobillo F, Vallés J, Broch MJ, Carrasco N, Herranz MA, Rello J. Antibiotic prescription for community-acquired pneumonia in the intensive care unit: impact of adherence to Infectious Disease Society of America guidelines on survival. Clin Infect Dis 2005;41:1709-1716.

8) Gattarello S, Borgatta B, Solé-Violán J, Vallés J, Vidaur L, Zaragoza R, Torres A, Rello J; Community-Acquired Pneumonia en la Unidad de Cuidados Intensivos II Study Investigators. Decrease in mortality in severe community-acquired pneumococcal pneumonia: impact of improving antibiotic strategies (2000-2013). Chest 2014;146:22-31.

9) Ewig S, Ruiz M, Mensa JM, Marcos MA, Martinez JA, Arancibia F, Niederman MS, Torres A. Severe community-acquired pneumonia: assessment of severity criteria. Am J Respir Crit Care Med 1988;158:1102-1108

10) Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med 1985;13:818-829.

11) Moreno RP, Metnitz PG, Almeida E, Jordan B, Bauer P, Campos RA, Iapichino G, Edbrooke D, Capuzzo M, Le Gall JR. SAPS 3: from evaluation of the patient to evaluation of the intensive care unit. Part 2: Development of a prognostic model for hospital mortality at ICU admission. Intensive Care Med 2005;31:1345-1355.

12) Gattarello S, Lagunes L, Vidaur L, Solé-Violán J, Zaragoza R, Vallés J, Torres A, Sierra R, Sebastian R, Rello J. Improvement of antibiotic therapy and ICU survival in severe non-pneumococcal community-acquired pneumonia: a matched case-control study. Crit Care 2015;19:335.

13) Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, Dowell SF, File TM Jr, Musher DM, Niederman MS, Torres A, Whitney CG. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis 2007; 44:27-72.

14) Rello J, Gattarello S, Souto J, Sole-Violan J, Valles J, Peredo R, Zaragoza R, Viadaur L, Parra A, Roig J. Community-acquired Legionella pneumophila in the intensive care unit: impact on survival of combined antibiotic therapy. Med Intensiva 2013;37:320-6.

15) Kumar G, Kumar N, Taneja A, Kaleekal T, Tarima S, McGinley E, Jimenez E, Mohan A, Khan RA, Whittle J, Jacobs E, Nanchal R. Nationwide trends of severe sepsis in the 21st century (2000-2007). Chest 2011;140:1223-1231.

16) The Acute Respiratory Distress Syndrome Network. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med 2000;342:1301-1308.

17) van Zanten AR, Sztark F, Kaisers UX, Zielmann S, Felbinger TW, Sablotzki AR, De Waele JJ, Timsit JF, Honing ML, Keh D, Vincent JL, Zazzo JF, Fijn HB, Petit L, Preiser JC, van Horssen PJ, Hofman Z. High-protein enteral nutrition enriched with immune-modulating nutrients vs. standard high-protein enteral nutrition and nosocomial infections in the ICU: a randomized clinical trial. JAMA 2014;312:514-524.

18) Alhazzani W, Alenezi F, Jaeschke RZ, Moayyedi P, Cook DJ. Proton pump inhibitors versus histamine 2 receptor antagonists for stress ulcer prophylaxis in critically ill patients: a systematic review and meta-analysis. Crit Care Med 2013;41:693-705.

19) Kumar A, Roberts D, Wood KE, Light B, Parrillo JE, Sharma S, Suppes R, Feinstein D, Zanotti S, Taiberg L, Gurka D, Kumar A, Cheang M. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med 2006;34:1589-1596.

20) Bordon J, Aliberti S, Duvvuri P, Wiemken T, Peyrani P, Natividad I, Caceres-Lara A, Delapeña R, Blasi F, Ramirez J. Early administration of the first antimicrobials should be considered a marker of optimal care of patients with community-acquired pneumonia rather than a predictor of outcomes. Int J Infect Dis 2013;17:293-298.

21) Simonetti AF, Garcia-Vidal C, Viasus D, Garcia-Somoza D, Dorca J, Gudiol F, Carratala J. Declining mortality among hospiotalized patients with community-acquired pneumonia. Clin Microbiol Infect 2016.22: 567e!-567.e7

22)  Gadsby NJ, Russell CD, McHugh MP, Mark H, Morris AC, Laurenson IF, Hill AT, Templeton K. Comprehensive molecular testing for respiratory pathogens in community-acquired pneumonia. Clin Infect Dis 2016;62:817-23.

23) Jain S, Self WH, Wunderink RG, Fakhran S, Balk R, Bramley AM, Reed C, Grijalva CG, Anderson EJ, Courtney DM, Chappell JD, Qi C, Hart EM, Carroll F, Trabue C, Donnelly HK, Williams DJ, Zhu Y, Arnold SR, Ampofo K, Waterer GW, Levine M, Lindstrom S, Winchell JM, Katz JM, Erdman D, Schneider E, Hicks LA, McCullers JA, Pavia AT, Edwards KM, Finelli L; CDC EPIC Study Team. Community-Acquired Pneumonia Requiring Hospitalization among U.S. Adults. N Engl J Med 2015;373:415-427.

Document: File 1
    This eLearning portal is powered by:
    This eLearning portal is powered by MULTIEPORTAL
Anonymous User Privacy Preferences

Strictly Necessary Cookies (Always Active)

MULTILEARNING platforms and tools hereinafter referred as “MLG SOFTWARE” are provided to you as pure educational platforms/services requiring cookies to operate. In the case of the MLG SOFTWARE, cookies are essential for the Platform to function properly for the provision of education. If these cookies are disabled, a large subset of the functionality provided by the Platform will either be unavailable or cease to work as expected. The MLG SOFTWARE do not capture non-essential activities such as menu items and listings you click on or pages viewed.

Performance Cookies

Performance cookies are used to analyse how visitors use a website in order to provide a better user experience.

Save Settings