Decrease in mortality in severe community-acquired pneumococcal pneumonia: impact of improving antibiotic strategies (2000-2013)

• Published in: Chest Vol. 146; no. 1; pp. 22 - 31
• Main Authors: Gattarello, Simone, Borgatta, Bárbara, Solé-Violán, Jordi, Vallés, Jordi, Vidaur, Loreto, Zaragoza, Rafael, Torres, Antoni, Rello, Jordi
• Format: Journal Article
• Language: English
• Published: United States 01-07-2014
• Subjects: Aged; Anti-Bacterial Agents - therapeutic use; Case-Control Studies; Community-Acquired Infections - diagnosis; Community-Acquired Infections - drug therapy; Community-Acquired Infections - mortality; Europe - epidemiology; Female; Follow-Up Studies; Humans; Intensive Care Units; Male; Middle Aged; Pneumonia, Pneumococcal - diagnosis; Pneumonia, Pneumococcal - drug therapy; Pneumonia, Pneumococcal - mortality; Practice Guidelines as Topic - standards; Prospective Studies; Risk Factors; Severity of Illness Index; Survival Rate - trends; Treatment Outcome; Europe
• ISSN: 1931-3543
• DOI: 10.1378/chest.13-1531

The objective of the present study was to compare antibiotic prescribing practices and survival in the ICU for patients with pneumococcal severe community-acquired pneumonia (SCAP) between 2000 and 2013.
This was a matched case-control study of two prospectively recorded cohorts in Europe. Eighty patients from the Community-Acquired Pneumonia en la Unidad de Cuidados Intensivos (CAPUCI) II study (case group) were matched with 80 patients from CAPUCI I (control group) based on the following: shock at admission, need of mechanical ventilation, COPD, immunosuppression, and age.
Demographic data were comparable in the two groups. Combined antibiotic therapy increased from 66.2% to 87.5% (P < .01), and the percentage of patients receiving the first dose of antibiotic within 3 h increased from 27.5% to 70.0% (P < .01). ICU mortality was significantly lower (OR, 0.82; 95% CI, 0.68-0.98) in cases, both in the whole population and in the subgroups of patients with shock (OR, 0.67; 95% CI, 0.50-0.89) or receiving mechanical ventilation (OR, 0.73; 95% CI, 0.55-0.96). In the multivariate analysis, ICU mortality increased in patients requiring mechanical ventilation (OR, 5.23; 95% CI, 1.60-17.17) and decreased in patients receiving early antibiotic treatment (OR, 0.36; 95% CI, 0.15-0.87) and combined therapy (OR, 0.19; 95% CI, 0.07-0.51).
In pneumococcal SCAP, early antibiotic prescription and use of combination therapy increased. Both were associated with improved survival.