Severe atypical pneumonia in critically ill patients: a retrospective multicenter study

doi:10.1186/s13613-018-0429-z

. 2018 Aug 13;8(1):81.

doi: 10.1186/s13613-018-0429-z.

Severe atypical pneumonia in critically ill patients: a retrospective multicenter study

S Valade^{1

2}, L Biard^{3

4}, V Lemiale^{5

3}, L Argaud⁶, F Pène⁷, L Papazian⁸, F Bruneel⁹, A Seguin¹⁰, A Kouatchet¹¹, J Oziel¹², S Rouleau¹³, N Bele¹⁴, K Razazi¹⁵, O Lesieur¹⁶, F Boissier¹⁷, B Megarbane¹⁸, N Bigé¹⁹, N Brulé²⁰, A S Moreau²¹, A Lautrette²², O Peyrony²³, P Perez²⁴, J Mayaux²⁵, E Azoulay^{5

3}

Affiliations

¹ AP-HP, Medical ICU, Hôpital Saint-Louis, 1 Avenue Claude Vellefaux, 75010, Paris, France. sandrine.valade@aphp.fr.
² UFR de Médecine, University Paris-7 Paris-Diderot, Paris, France. sandrine.valade@aphp.fr.
³ UFR de Médecine, University Paris-7 Paris-Diderot, Paris, France.
⁴ AP-HP, DBIM, Hôpital Saint-Louis, Paris, France.
⁵ AP-HP, Medical ICU, Hôpital Saint-Louis, 1 Avenue Claude Vellefaux, 75010, Paris, France.
⁶ Hôpital Edouard Herriot, Service de Réanimation Médicale, Hospices Civils de Lyon, Lyon, France.
⁷ AP-HP, Réanimation médicale, Hôpital Cochin, Paris, France.
⁸ Réanimation des Détresses Respiratoires et Infections Sévères, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Marseille, France.
⁹ Service de Réanimation, Centre Hospitalier de Versailles, Le Chesnay, France.
¹⁰ Department of Medical Intensive Care, CHU de Caen, Caen, France.
¹¹ Service de Réanimation Médicale et Médecine Hyperbare, Hôpital Angers, Angers, France.
¹² AP-HP, Medical-Surgical Intensive Care Unit, Avicenne University Hospital, Bobigny, France.
¹³ Service de Réanimation polyvalente, Angoulême, France.
¹⁴ Intensive Care Unit, Draguignan Hospital, Draguignan, France.
¹⁵ AP-HP, Groupe Henri Mondor-Albert Chenevier, Service de Réanimation Médicale, Hôpital Henri Mondor, Créteil, France.
¹⁶ Service de Réanimation, CH Saint-Louis, La Rochelle, France.
¹⁷ AP-HP, Réanimation médicale, Hôpital Européen Georges Pompidou, Paris, France.
¹⁸ AP-HP, Department of Medical and Toxicological Critical Care, Lariboisière Hospital, Paris, France.
¹⁹ AP-HP, Medical Intensive Care Unit, Hôpital Saint-Antoine, Paris, France.
²⁰ Medical Intensive Care Unit, Centre Hospitalier Universitaire de Nantes, Nantes, France.
²¹ Centre de réanimation, Hôpital Salengro, CHU-Lille, Lille, France.
²² Service de Réanimation Médicale Polyvalente, CHU Gabriel Montpied, Clermont-Ferrand, France.
²³ AP-HP, Service des urgences, Hôpital Saint-Louis, Paris, France.
²⁴ Service de Réanimation médicale, Hôpital Brabois, Nancy, France.
²⁵ AP-HP, Pneumology and Critical Care Medicine Department, Universitary Hospital La Pitié Salpêtrière-Charles Foix, Paris, France.

PMID: 30105627
PMCID: PMC6089852
DOI: 10.1186/s13613-018-0429-z

Severe atypical pneumonia in critically ill patients: a retrospective multicenter study

S Valade et al. Ann Intensive Care. 2018.

. 2018 Aug 13;8(1):81.

doi: 10.1186/s13613-018-0429-z.

Authors

Affiliations

¹ AP-HP, Medical ICU, Hôpital Saint-Louis, 1 Avenue Claude Vellefaux, 75010, Paris, France. sandrine.valade@aphp.fr.
² UFR de Médecine, University Paris-7 Paris-Diderot, Paris, France. sandrine.valade@aphp.fr.
³ UFR de Médecine, University Paris-7 Paris-Diderot, Paris, France.
⁴ AP-HP, DBIM, Hôpital Saint-Louis, Paris, France.
⁵ AP-HP, Medical ICU, Hôpital Saint-Louis, 1 Avenue Claude Vellefaux, 75010, Paris, France.
⁶ Hôpital Edouard Herriot, Service de Réanimation Médicale, Hospices Civils de Lyon, Lyon, France.
⁷ AP-HP, Réanimation médicale, Hôpital Cochin, Paris, France.
⁸ Réanimation des Détresses Respiratoires et Infections Sévères, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Marseille, France.
⁹ Service de Réanimation, Centre Hospitalier de Versailles, Le Chesnay, France.
¹⁰ Department of Medical Intensive Care, CHU de Caen, Caen, France.
¹¹ Service de Réanimation Médicale et Médecine Hyperbare, Hôpital Angers, Angers, France.
¹² AP-HP, Medical-Surgical Intensive Care Unit, Avicenne University Hospital, Bobigny, France.
¹³ Service de Réanimation polyvalente, Angoulême, France.
¹⁴ Intensive Care Unit, Draguignan Hospital, Draguignan, France.
¹⁵ AP-HP, Groupe Henri Mondor-Albert Chenevier, Service de Réanimation Médicale, Hôpital Henri Mondor, Créteil, France.
¹⁶ Service de Réanimation, CH Saint-Louis, La Rochelle, France.
¹⁷ AP-HP, Réanimation médicale, Hôpital Européen Georges Pompidou, Paris, France.
¹⁸ AP-HP, Department of Medical and Toxicological Critical Care, Lariboisière Hospital, Paris, France.
¹⁹ AP-HP, Medical Intensive Care Unit, Hôpital Saint-Antoine, Paris, France.
²⁰ Medical Intensive Care Unit, Centre Hospitalier Universitaire de Nantes, Nantes, France.
²¹ Centre de réanimation, Hôpital Salengro, CHU-Lille, Lille, France.
²² Service de Réanimation Médicale Polyvalente, CHU Gabriel Montpied, Clermont-Ferrand, France.
²³ AP-HP, Service des urgences, Hôpital Saint-Louis, Paris, France.
²⁴ Service de Réanimation médicale, Hôpital Brabois, Nancy, France.
²⁵ AP-HP, Pneumology and Critical Care Medicine Department, Universitary Hospital La Pitié Salpêtrière-Charles Foix, Paris, France.

PMID: 30105627
PMCID: PMC6089852
DOI: 10.1186/s13613-018-0429-z

Abstract

Background: Chlamydophila pneumoniae (CP) and Mycoplasma pneumoniae (MP) patients could require intensive care unit (ICU) admission for acute respiratory failure.

Methods: Adults admitted between 2000 and 2015 to 20 French ICUs with proven atypical pneumonia were retrospectively described. Patients with MP were compared to Streptococcus pneumoniae (SP) pneumonia patients admitted to ICUs.

Results: A total of 104 patients were included, 71 men and 33 women, with a median age of 56 [44-67] years. MP was the causative agent for 76 (73%) patients and CP for 28 (27%) patients. Co-infection was documented for 18 patients (viruses for 8 [47%] patients). Median number of involved quadrants on chest X-ray was 2 [1-4], with alveolar opacities (n = 61, 75%), interstitial opacities (n = 32, 40%). Extra-pulmonary manifestations were present in 34 (33%) patients. Mechanical ventilation was required for 75 (72%) patients and vasopressors for 41 (39%) patients. ICU length of stay was 16.5 [9.5-30.5] days, and 11 (11%) patients died in the ICU. Compared with SP patients, MP patients had more extensive interstitial pneumonia, fewer pleural effusion, and a lower mortality rate [6 (8%) vs. 17 (22%), p = 0.013]. According MCA analysis, some characteristics at admission could discriminate MP and SP. MP was more often associated with hemolytic anemia, abdominal manifestations, and extensive chest radiograph abnormalities. SP-P was associated with shock, confusion, focal crackles, and focal consolidation.

Conclusion: In this descriptive study of atypical bacterial pneumonia requiring ICU admission, mortality was 11%. The comparison with SP pneumonia identified clinical, laboratory, and radiographic features that may suggest MP or CP pneumonia.

Keywords: Chlamydophila pneumoniae; ICU; Mycoplasma pneumoniae; Outcome; Pneumonia.

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Figures

**Fig. 1**
Distribution of atypical pneumonia cases by season and year

**Fig. 2**
Multiple correspondence analysis: the factors are mapped along two dimensions. Triangles indicate pulmonary signs and squares extra-pulmonary signs. HA hemolytic anemia, *Cold agglu+* presence of cold agglutinins, QD quadrants

See this image and copyright information in PMC

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[1] Cillóniz C, Torres A, Niederman M, van der Eerden M, Chalmers J, Welte T, et al. Community-acquired pneumonia related to intracellular pathogens. Intensive Care Med. 2016;42(9):1374–1386. doi: 10.1007/s00134-016-4394-4. - DOI - PubMed

[2] Cillóniz C, Torres A, Niederman M, van der Eerden M, Chalmers J, Welte T, et al. Community-acquired pneumonia related to intracellular pathogens. Intensive Care Med. 2016;42(9):1374–1386. doi: 10.1007/s00134-016-4394-4. - DOI - PubMed

[3] Ngeow Y-F, Suwanjutha S, Chantarojanasriri T, Wang F, Saniel M, Alejandria M, et al. An Asian study on the prevalence of atypical respiratory pathogens in community-acquired pneumonia. Int J Infect Dis. 2005;9(3):144–153. doi: 10.1016/j.ijid.2004.06.006. - DOI - PubMed

[4] Ngeow Y-F, Suwanjutha S, Chantarojanasriri T, Wang F, Saniel M, Alejandria M, et al. An Asian study on the prevalence of atypical respiratory pathogens in community-acquired pneumonia. Int J Infect Dis. 2005;9(3):144–153. doi: 10.1016/j.ijid.2004.06.006. - DOI - PubMed

[5] Saraya T, Kurai D, Nakagaki K, Sasaki Y, Niwa S, Tsukagoshi H, et al. Novel aspects on the pathogenesis of Mycoplasma pneumoniae pneumonia and therapeutic implications. Front Microbiol. 2014 Aug 11. Cited 2015 Jun 24; 5. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4127663/. - PMC - PubMed

[6] Saraya T, Kurai D, Nakagaki K, Sasaki Y, Niwa S, Tsukagoshi H, et al. Novel aspects on the pathogenesis of Mycoplasma pneumoniae pneumonia and therapeutic implications. Front Microbiol. 2014 Aug 11. Cited 2015 Jun 24; 5. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4127663/. - PMC - PubMed

[7] von Baum H, Welte T, Marre R, Suttorp N, Lück C, Ewig S. Mycoplasma pneumoniae pneumonia revisited within the German Competence Network for Community-acquired pneumonia (CAPNETZ) BMC Infect Dis. 2009;9:62. doi: 10.1186/1471-2334-9-62. - DOI - PMC - PubMed

[8] von Baum H, Welte T, Marre R, Suttorp N, Lück C, Ewig S. Mycoplasma pneumoniae pneumonia revisited within the German Competence Network for Community-acquired pneumonia (CAPNETZ) BMC Infect Dis. 2009;9:62. doi: 10.1186/1471-2334-9-62. - DOI - PMC - PubMed

[9] Marrie TJ. Mycoplasma pneumoniae pneumonia requiring hospitalization, with emphasis on infection in the elderly. Arch Intern Med. 1993;153(4):488–494. doi: 10.1001/archinte.1993.00410040054008. - DOI - PubMed

[10] Marrie TJ. Mycoplasma pneumoniae pneumonia requiring hospitalization, with emphasis on infection in the elderly. Arch Intern Med. 1993;153(4):488–494. doi: 10.1001/archinte.1993.00410040054008. - DOI - PubMed

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Severe atypical pneumonia in critically ill patients: a retrospective multicenter study

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Severe atypical pneumonia in critically ill patients: a retrospective multicenter study

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