Host-pathogen interactions and prognosis ...
Document type :
Article dans une revue scientifique
PMID :
Permalink :
Title :
Host-pathogen interactions and prognosis of critically ill immunocompetent patients with pneumococcal pneumonia: the nationwide prospective observational STREPTOGENE study.
Author(s) :
Bedos, Jean-Pierre [Auteur]
Varon, Emmanuelle [Auteur]
Porcher, Raphael [Auteur]
Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité [CRESS (U1153 / UMR_A_1125 / UMR_S_1153)]
Asfar, Pierre [Auteur]
Le Tulzo, Yves [Auteur]
Megarbane, Bruno [Auteur]
Mathonnet, Armelle [Auteur]
Dugard, Anthony [Auteur]
Veinstein, Anne [Auteur]
Ouchenir, Kader [Auteur]
Siami, Shidasp [Auteur]
Reignier, Jean [Auteur]
Galbois, Arnaud [Auteur]
Cousson, Joel [Auteur]
Preau, Sebastien [Auteur]
Lille Inflammation Research International Center - U 995 [LIRIC]
Baldesi, Olivier [Auteur]
Rigaud, Jean-Philippe [Auteur]
Souweine, Bertrand [Auteur]
Misset, Benoit [Auteur]
Jacobs, Frederic [Auteur]
Dewavrin, Florent [Auteur]
Mira, Jean-Paul [Auteur]
Varon, Emmanuelle [Auteur]
Porcher, Raphael [Auteur]
Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité [CRESS (U1153 / UMR_A_1125 / UMR_S_1153)]
Asfar, Pierre [Auteur]
Le Tulzo, Yves [Auteur]
Megarbane, Bruno [Auteur]
Mathonnet, Armelle [Auteur]
Dugard, Anthony [Auteur]
Veinstein, Anne [Auteur]
Ouchenir, Kader [Auteur]
Siami, Shidasp [Auteur]
Reignier, Jean [Auteur]
Galbois, Arnaud [Auteur]
Cousson, Joel [Auteur]
Preau, Sebastien [Auteur]
Lille Inflammation Research International Center - U 995 [LIRIC]
Baldesi, Olivier [Auteur]
Rigaud, Jean-Philippe [Auteur]
Souweine, Bertrand [Auteur]
Misset, Benoit [Auteur]
Jacobs, Frederic [Auteur]
Dewavrin, Florent [Auteur]
Mira, Jean-Paul [Auteur]
Journal title :
Intensive Care Medicine
Abbreviated title :
Intensive Care Med.
Volume number :
44
Pages :
2162–2173
Publication date :
2018-12
Keyword(s) :
Pneumococcal pneumonia
Intensive care unit
Macrolides
Fluoroquinolones
Pneumococcal serotypes
Severe community-acquired pneumonia
Intensive care unit
Macrolides
Fluoroquinolones
Pneumococcal serotypes
Severe community-acquired pneumonia
HAL domain(s) :
Sciences du Vivant [q-bio]
English abstract : [en]
Purpose: To assess the relative importance of host and bacterial factors associated with hospital mortality in patients admitted to the intensive care unit (ICU) for pneumococcal community-acquired pneumonia (PCAP).
Methods: ...
Show more >Purpose: To assess the relative importance of host and bacterial factors associated with hospital mortality in patients admitted to the intensive care unit (ICU) for pneumococcal community-acquired pneumonia (PCAP). Methods: Immunocompetent Caucasian ICU patients with PCAP documented by cultures and/or pneumococcal urinary antigen (UAg Sp) test were included in this multicenter prospective study between 2008 and 2012. All pneumococcal strains were serotyped. Logistic regression analyses were performed to identify risk factors for hospital mortality. Results Of the 614 patients, 278 (45%) had septic shock, 270 (44%) had bacteremia, 307 (50%) required mechanical ventilation at admission, and 161 (26%) had a diagnosis based only on the UAg Sp test. No strains were penicillin-resistant, but 23% had decreased susceptibility. Of the 36 serotypes identified, 7 accounted for 72% of the isolates, with different distributions according to age. Although antibiotics were consistently appropriate and were started within 6 h after admission in 454 (74%) patients, 116 (18.9%) patients died. Independent predictors of hospital mortality in the adjusted analysis were platelets ≤ 100 × 109/L (OR, 7.7; 95% CI, 2.8–21.1), McCabe score ≥ 2 (4.58; 1.61–13), age > 65 years (2.92; 1.49–5.74), lactates > 4 mmol/L (2.41; 1.27–4.56), male gender and septic shock (2.23; 1.30–3.83 for each), invasive mechanical ventilation (1.78; 1–3.19), and bilateral pneumonia (1.59; 1.02–2.47). Women with platelets ≤ 100 × 109/L had the highest mortality risk (adjusted OR, 7.7; 2.8–21). Conclusions: In critically ill patients with PCAP, age, gender, and organ failures at ICU admission were more strongly associated with hospital mortality than were comorbidities. Neither pneumococcal serotype nor antibiotic regimen was associated with hospital mortality.Show less >
Show more >Purpose: To assess the relative importance of host and bacterial factors associated with hospital mortality in patients admitted to the intensive care unit (ICU) for pneumococcal community-acquired pneumonia (PCAP). Methods: Immunocompetent Caucasian ICU patients with PCAP documented by cultures and/or pneumococcal urinary antigen (UAg Sp) test were included in this multicenter prospective study between 2008 and 2012. All pneumococcal strains were serotyped. Logistic regression analyses were performed to identify risk factors for hospital mortality. Results Of the 614 patients, 278 (45%) had septic shock, 270 (44%) had bacteremia, 307 (50%) required mechanical ventilation at admission, and 161 (26%) had a diagnosis based only on the UAg Sp test. No strains were penicillin-resistant, but 23% had decreased susceptibility. Of the 36 serotypes identified, 7 accounted for 72% of the isolates, with different distributions according to age. Although antibiotics were consistently appropriate and were started within 6 h after admission in 454 (74%) patients, 116 (18.9%) patients died. Independent predictors of hospital mortality in the adjusted analysis were platelets ≤ 100 × 109/L (OR, 7.7; 95% CI, 2.8–21.1), McCabe score ≥ 2 (4.58; 1.61–13), age > 65 years (2.92; 1.49–5.74), lactates > 4 mmol/L (2.41; 1.27–4.56), male gender and septic shock (2.23; 1.30–3.83 for each), invasive mechanical ventilation (1.78; 1–3.19), and bilateral pneumonia (1.59; 1.02–2.47). Women with platelets ≤ 100 × 109/L had the highest mortality risk (adjusted OR, 7.7; 2.8–21). Conclusions: In critically ill patients with PCAP, age, gender, and organ failures at ICU admission were more strongly associated with hospital mortality than were comorbidities. Neither pneumococcal serotype nor antibiotic regimen was associated with hospital mortality.Show less >
Language :
Anglais
Audience :
Internationale
Popular science :
Non
Administrative institution(s) :
Inserm
Université de Lille
CHU Lille
Université de Lille
CHU Lille
Research team(s) :
Glycation from inflammation to aging
Submission date :
2019-03-01T14:26:56Z
2023-12-07T15:12:41Z
2023-12-07T15:12:41Z