Intensive Care Medicine

, Volume 22, Issue 12, pp 1301–1306 | Cite as

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

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

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 pneumonia Community-acquired Outcome Intensive care 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Prout S, Potgieter PD, Forder AA, Moodie JW, Matthews J (1983) Acute community-acquired pneumonias. S Afr Med J 64: 443–446PubMedGoogle Scholar
  2. 2.
    Marrie TJ (1994) Community-acquired pneumonia. Clin Infect Dis 18: 501–513PubMedGoogle Scholar
  3. 3.
    Macfarlane JT, Finch RG, Ward MJ, Macrae AD (1982) Hospital study of adult community-acquired pneumonia. Lancet J I: 255–258Google Scholar
  4. 4.
    Ortqvist A, Sterner G, Nilsson A (1985) Severe community-acquired pneumonia: factors influencing need of intensive care treatment and prognosis. Scand J Infect Dis 17: 377–386PubMedGoogle Scholar
  5. 5.
    Austrian R (1986) Pneumococcal pneumonia. Diagnostic, epidemiologic, therapeutic and prophylactic considerations. Chest 90: 738–743PubMedGoogle Scholar
  6. 6.
    Kramer MR, Rudensky B, Haddas-Halperin I, Isacsohn M, Melzer E (1987) Pneumococcal bacteraemia: no change in mortality over 30 years-analysis of 104 cases and review of the literature. Isr J Med Sci 23: 174–180PubMedGoogle Scholar
  7. 7.
    Hook EW, Horton CA, Schaberg DR (1983) Failure of intensive care unit support to influence mortality from pneumococcal bacteremia. JAMA 249: 1055–1057PubMedGoogle Scholar
  8. 8.
    Banks RA, George RC, McNicol MW (1984) Pneumococcal pneumonia with bacteraemia. Respir Med 78: 352–357Google Scholar
  9. 9.
    Ortqvist A, Kalin M, Julander I, Mufson MA (1993) Deaths in bacteremic pneumococcal pneumonia. Chest 103: 710–716PubMedGoogle Scholar
  10. 10.
    Breiman RF, Spika JS, Navarro VJ, Darden PM, Darby CP (1990) Pneumococcal bacteremia in Charleston County, South Carolina: a decade later. Arch Intern Med 150: 1401–1405PubMedGoogle Scholar
  11. 11.
    Pesola GR, Allison C (1992) Pneumococcal Bacteremia with pneumonia. Mortality in acquired immunodeficiency syndrome. Chest 101: 150–155PubMedGoogle Scholar
  12. 12.
    Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) APACHE 2: a severity of disease classification system. Crit Care Med 13: 818–829PubMedGoogle Scholar
  13. 13.
    Murray JF, Matthay MA, Luce JM, Flick MR (1988) An expanded definition of the adult respiratory distress syndrome. Am J Respir Crit Care Med 138: 720–723Google Scholar
  14. 14.
    Andrews BE, Bartlett CLR, Connolly CK, Ellis DA, Farr BM, Harrison BDW (1987) Community-acquired pneumonia in adults in British hospitals in 1982–1983: a survey of aetiology, mortality, prognostic factors and outcome. Q J Med 62: 195–220PubMedGoogle Scholar
  15. 15.
    Knaus WA, Draper EA, Wagner DP (1985) Prognosis in acute organ system failure. Ann Surg 202: 685–690PubMedGoogle Scholar
  16. 16.
    Sorensen J, Forsberg P, Hakason E, Maller R, Sederholm C, Soren L, Carlsson C (1989) A new diagnostic approach to the patient with severe pneumonia. Scand J Infect Dis 21: 33–41PubMedGoogle Scholar
  17. 17.
    Torres A, Serra-Batlles J, Ferrer A, Jimenez P, Celis R, Cobo E, Rodiriguez-Roisin R (1991) Severe community-acquired pneumonia. Am J Respir Crit Care Med 144: 312–318Google Scholar
  18. 18.
    Marrie TJ (1992) Bacteraemic pneumococcal pneumonia: a continuously evolving disease. J Infect 24: 247–256PubMedGoogle Scholar
  19. 19.
    Bruyn GAW, van der Meer JWM, Hermans J, Knoppert W (1988) Pneumococcal bacteraemia over a 10-year period at University Hospital, Leiden. Rev Infect Dis 10: 446–450PubMedGoogle Scholar
  20. 20.
    Brett A, Sinclair DG (1993) Use of continuous positive airway pressure in the management of community acquired pneumonia. Thorax 48: 1280–1281PubMedGoogle Scholar
  21. 21.
    Tuxen DV (1994) Permissive hypercapnic ventilation. Am J Respir Crit Care Med 150: 870–874PubMedGoogle Scholar
  22. 22.
    Marini JJ (1994) Pressure-targeted, lung-protective ventilatory support in acute lung injury. Chest 105: 109S-115SPubMedGoogle Scholar
  23. 23.
    Pallares R, Linares J, Vadillo M, Cabellos C, Manresa F, Viladrich PF, Martin R, Gudiol F (1995) Resistance to penicillin and cephalosporin and mortality from severe pneumococcal pneumonia in Barcelona, Spain. N Engl J Med 333: 474–480PubMedGoogle Scholar
  24. 24.
    Hofmann J, Cetron MS, Farley MM, Baughman WS, Facklam RR, Elliott JA, Deaver KA, Breiman RF (1995) The prevalence of drug-resistantStreptococcus pneumoniae in Atlanta. N Engl J Med 333: 481–486PubMedGoogle Scholar
  25. 25.
    Pittet D, Thie'vent B, Wenzel RP, Ning L, Auckenthaler R, Suter P (1996) Bedside prediction of mortality from bacteremic sepsis. Am J Respir Crit Care Med 153: 684–693PubMedGoogle Scholar
  26. 26.
    Kuikka A, Syrjanen J, Renkonen OV, Valtonen VV (1992) Pneumococcal bacteraemia during a recent decade. J Infect 24: 157–168PubMedGoogle Scholar

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

Personalised recommendations