Intensive Care Medicine

, Volume 22, Issue 12, pp 1301–1306

The intensive care management, mortality and prognostic indicators in severe community-acquired pneumococcal pneumonia

  • P. D. Potgieter
  • J. M. J. Hammond
Original

DOI: 10.1007/BF01709542

Cite this article as:
Potgieter, P.D. & Hammond, J.M.J. Intensive Care Med (1996) 22: 1301. doi:10.1007/BF01709542

Abstract

Objective

To determine mortality and factors that might predict outcome in severe community-acquired pneumococcal pneumonia treated by a standard protocol.

Design

Prospective, nonconcurrent study.

Setting

Respiratory intensive care unit (ICU) in a teaching hospital by positive blood culture.

Patients

63 patients who were diagnosed by positive blood culture or Gram stain and culture of sputum or tracheal aspirate were included.

Measurements and results

Clinical features, severity scores including Acute Physiology and Chronic Health Evaluation (APACHE) II, organ failure and lung injury scores, and the clinical course in the ICU were documented; 79% of patients required mechanical ventilation. Bacteraemia was present in 34 patients (54%); there were no distinguishing clinical features between bacteraemic and non-bacteraemic cases. The overall mortality was 21%, with only 5 deaths (15% mortality) in the bacteraemic group. Shock and a very low serum albumin (<26 g/l) were the only clinical features that differentiated survivors from non-survivors; lung injury, APACHE II and multiple organ failure scores were all predictive of outcome. The positive predictive value and specificity in predicting death in individuals for the modified British Thoracic Society rule 1 were 26 and 64%; APACHE II>20 57 and 88%; >2 organ failure 64 and 92%; and lung injury >2 33 and 73%, respectively.

Conclusions

These results suggest that even in bacteraemic cases mortality should be below 25% with intensive care management and that conventional scoring systems, while predictive of group mortality, are unreliable in individuals.

Key words

Pneumococcal pneumoniaCommunity-acquiredOutcomeIntensive care

Copyright information

© Springer-Verlag 1996

Authors and Affiliations

  • P. D. Potgieter
    • 1
  • J. M. J. Hammond
    • 1
  1. 1.Respiratory Intensive Care Unit, Department of Anaesthesia and MedicineGroote Schuur HospitalCape TownSouth Africa
  2. 2.King Fahad National Guard HospitalRiyadhKingdom of Saudi Arabia
  3. 3.Department of Clinical PharmacologyThe Johns Hopkins University Medical CentreBaltimoreUSA