Intensive Care Medicine

, Volume 21, Issue 1, pp 24–31 | Cite as

A five-year study of severe community-acquired pneumonia with emphasis on prognosis in patients admitted to an intensive care unit

  • O. Leroy
  • C. Santré
  • C. Beuscart
  • H. Georges
  • B. Guery
  • J. M. Jacquier
  • G. Beaucaire



To characterize the epidemiology and to determine the prognosis factors in severe community-acquired pneumonia among patients admitted to an intensive care unit.


Retrospective clinical study.


Intensive Care and Infectious Diseases Unit of a municipal general hospital of Lille University Medical School.


299 consecutive patients exhibiting severe community-acquired pneumonia.

Measurements and results

On admission to ICU, 149 patients required mechanical ventilation for acute respiratory failure and 44 exhibited septic shock. Pulmonary involvement was bilateral in 71 patients. There were 260 organisms isolated from 197 patients (65.9%), the most frequent beingStreptococcus pneumoniae (n=80),Staphylococcus spp. (n=57) and Gram-negative bacilli (n=81). Overall mortality was 28.5% (85 patients). According to univariate analysis, mortality was associated with age over 60 years, anticipated death within 5 years, immunosuppression, shock, mechanical ventilation, bilateral pulmonary involvement, bacteremia, neutrophil count <3500/mm3, total serum protein level <45 g/l, serum creatinine >15 mg/l, non-aspiration pneumonia, ineffective initial therapy and complications. Multivariate analysis selected only 5 factors significantly associated with prognosis: anticipated death within 5 years, shock, bacteremia, non-pneumonia-related complications and ineffective initial therapy.


The effectiveness of the initial therapy appears to be the most significant prognosis factor and, as the one and only related to the initial medical intervention, suggests a need for permanent optimization of our antimicrobial strategies.

Key words

Community-acquired pneumonia Prognosis Epidemiology Critically ill patients 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Fine MJ, Smith DN, Singer DE (1990) Hospitalization decision in patients with community-acquired pneumonia: a prospective cohort study. Am J Med 89:713–721PubMedCrossRefGoogle Scholar
  2. 2.
    Fine MJ, Singer DE, Hanusa BH, Lave JR, Kapoor WN (1993) Validation of a pneumonia prognostic index using the medisgroups comparative hospital database. Am J Med 94:153–159PubMedCrossRefGoogle Scholar
  3. 3.
    Van Eeden SF, Coetzee AR, Joubert JR (1988) Community-acquired pneumonia — factors influencing intensive care admission. S Afr Med J 73:77–81PubMedGoogle Scholar
  4. 4.
    Fang GD, Fine M, Orloff J, Arisumi D, Yu VL, Kapoor W, Grayston T, Wang SP, Kohler R, Muder RR, Yee YC, Riks JD, Vickers RM (1990) New and emerging etiologies for community-acquired pneumonia with implications for therapy. A prospective multicenter study of 359 cases. Medicine 69:307–316PubMedGoogle Scholar
  5. 5.
    Torres A, Serra-Batlles J, Ferrer A, Jiminez P, Celis R, Cobo E, Rodriguez-Roisin R (1991) Severe community-acquired pneumonia. Epidemiology and prognostic factors. Am Rev Respir Dis 144:312–318PubMedGoogle Scholar
  6. 6.
    Fine MJ, Orloff JJ, Arisumi D, Fang G, Arena VC, Hanusa BH, Yu VL, Singer DE, Kapoor WN (1990) Prognosis of patients hospitalized with community-acquired pneumonia. Am J Med 88 [Suppl 5]:1N-8NPubMedGoogle Scholar
  7. 7.
    Thompson RL (1987) Surveillance and reporting of nosocomial infections. In: Wenzel RP (ed) Prevention and control of nosocomial infections. Williams and Wilkins, Baltimore, pp 70–82Google Scholar
  8. 8.
    McCabe WR, Jackson CG (1962) Gram-negative bacteremia: etiology and ecology. Arch Intern Med 110:847–855Google Scholar
  9. 9.
    Le Gall JR, Loirat P, Alperovitch A (1983) Simplified acute physiologic score for intensive care patient. Lancet II:741CrossRefGoogle Scholar
  10. 10.
    Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) Prognosis in acute organ system failure. Ann Surg 6:685Google Scholar
  11. 11.
    Bone RC, Fisher CJ, Clemmer TP, Slotman GJ, Metz CA, Balk RA (1989) The methylprednisolone severe sepsis study group. Sepsis syndrome: a valid clinical entity. Crit Care Med 17:389–393PubMedCrossRefGoogle Scholar
  12. 12.
    Teasdale G, Jennet B (1974) Assessment of coma and impaired consciousness. Lancet II:81CrossRefGoogle Scholar
  13. 13.
    Pachon J, Prados MD, Capote F, Cuello JA, Garnacho J, Verano A (1990) Severe community-acquired pneumonia. Etiology, prognosis, and treatment. Am Rev Respir Dis 142: 369–373PubMedGoogle Scholar
  14. 14.
    Levy M, Dromer F, Brion N, Leturdu F, Carbon C (1988) Community-acquired pneumonia. Importance of initial noninvasive bacteriologic and radiographic investigations. Chest 92:43–48Google Scholar
  15. 15.
    Research Committee of the British Thoracic Society and the Public Health Laboratory Service (1987) Community-acquired pneumonia in adults in British hospitals in 1982–1983: a survey of aetiology, mortality, prognosis factors and outcome. Q J Med 62:195–220Google Scholar
  16. 16.
    Marrie TJ, Durant H, Yates L (1989) Community-acquired pneumonia requiring hospitalization: 5-year prospective study. Rev Infect Dis 11:586–599PubMedGoogle Scholar
  17. 17.
    Richard V, Lepoutre A (1993) Les cas de legionellose déclarés en France en 1991 et 1992. BEH 30:133–134Google Scholar
  18. 18.
    Farr BM, Sloman AJ, Fisch MJ (1991) Predicting death in patients hospitalized for community-acquired pneumonia. Ann Intern Med 115:428–436PubMedGoogle Scholar
  19. 19.
    McNabb WR, Shanson DC, Williams TDM, Lant AF (1984) Adult community-acquired pneumonia in central London. J R Soc Med 77:550–555PubMedGoogle Scholar
  20. 20.
    Ortqvist A, Sterner G, Nilsson JA (1985) Severe community-acquired pneumonia: factors influencing need in intensive care treatment and prognosis. Scand J Infect Dis 17:377–386PubMedGoogle Scholar
  21. 21.
    Feldman C, Kallenbach JM, Levy H, Reinach SG, Hurwitz MD, Thorburn JR, Koornhof HJ (1989) Community-acquired pneumonia of diverse aetiology: prognostic features in patients admitted to an intensive care unit and a “severity of illness” score. Intensive Care Med 15:302–307PubMedCrossRefGoogle Scholar
  22. 22.
    Hickling KG, Howard R (1988) A retrospective survey of treatment and mortality in aspiration pneumonia. Intensive Care Med 14:617–622PubMedCrossRefGoogle Scholar
  23. 23.
    Leroy O, Beuscart C, Mouton, Y (1988) Gram-negative nosocomial infection: incidence, pathogens, compromised host. Br J Clin Pract 42:27–35Google Scholar

Copyright information

© Springer-Verlag 1995

Authors and Affiliations

  • O. Leroy
    • 1
  • C. Santré
    • 1
  • C. Beuscart
    • 1
  • H. Georges
    • 1
  • B. Guery
    • 1
  • J. M. Jacquier
    • 1
  • G. Beaucaire
    • 1
  1. 1.Intensive Care and Infectious Diseases UnitLille University Medical SchoolTourcoingFrance

Personalised recommendations