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. 2015 Dec 23:19:450.
doi: 10.1186/s13054-015-1165-5.

Polymicrobial intensive care unit-acquired pneumonia: prevalence, microbiology and outcome

Miquel Ferrer  1   2   3 , Leonardo Filippo Difrancesco  4   5 , Adamantia Liapikou  6   7 , Mariano Rinaudo  8 , Marco Carbonara  9   10 , Gianluigi Li Bassi  11   12   13 , Albert Gabarrus  14   15 , Antoni Torres  16   17   18
Affiliations

Polymicrobial intensive care unit-acquired pneumonia: prevalence, microbiology and outcome

Miquel Ferrer et al. Crit Care. .

Abstract

Background: Microbial aetiology of intensive care unit (ICU)-acquired pneumonia (ICUAP) determines antibiotic treatment and outcomes. The impact of polymicrobial ICUAP is not extensively known. We therefore investigated the characteristics and outcomes of polymicrobial aetiology of ICUAP.

Method: Patients with ICUAP confirmed microbiologically were prospectively compared according to identification of 1 (monomicrobial) or more (polymicrobial) potentially-pathogenic microorganisms. Microbes usually considered as non-pathogenic were not considered for the etiologic diagnosis. We assessed clinical characteristics, microbiology, inflammatory biomarkers and outcome variables.

Results: Among 441 consecutive patients with ICUAP, 256 (58%) had microbiologic confirmation, and 41 (16%) of them polymicrobial pneumonia. Methicillin-sensitive Staphylococcus aureus, Haemophilus influenzae, and several Enterobacteriaceae were more frequent in polymicrobial pneumonia. Multi-drug and extensive-drug resistance was similarly frequent in both groups. Compared with monomicrobial, patients with polymicrobial pneumonia had less frequently chronic heart disease (6, 15% vs. 71, 33%, p = 0.019), and more frequently pleural effusion (18, 50%, vs. 54, 25%, p = 0.008), without any other significant difference. Appropriate empiric antimicrobial treatment was similarly frequent in the monomicrobial (185, 86%) and the polymicrobial group (39, 95%), as were the initial response to the empiric treatment, length of stay and mortality. Systemic inflammatory response was similar comparing monomicrobial with polymicrobial ICUAP.

Conclusion: The aetiology of ICUAP confirmed microbiologically was polymicrobial in 16% cases. Pleural effusion and absence of chronic heart disease are associated with polymicrobial pneumonia. When empiric treatment is frequently appropriate, polymicrobial aetiology does not influence the outcome of ICUAP.

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Figures

Fig. 1
Fig. 1
Trial profile of included and excluded patients. ICU intensive care unit, VAP ventilator-associated pneumonia, ICUAP ICU-acquired pneumonia
Fig. 2
Fig. 2
Kaplan-Meier survival curves at 28 and 90 days in the study cohort survivors in patients with monomicrobial and polymicrobial pneumonia
See this image and copyright information in PMC

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