Severe community-acquired pneumonia in intensive care

Abstract

Aim: To describe the characteristics of patients with severe pneumonia treated in Czech intensive care units (ICU) and to compare this study group with the available European and world literature data.

Material and methods: The prospective observational study launched on 1 September 2017 includes adult patients with community-acquired pneumonia from three Czech ICUs. It focuses on demographic data, chronic comorbidity, clinical and laboratory parameters, X-ray findings, microbiological findings, therapeutic procedures, and treatment outcomes. Results: As of 31 May 2019, 74 patients, 21 females and 53 males, were included in the study. Fifty-three (71.6%) patients had an underlying chronic disease. Only one patient was vaccinated against influenza and pneumococcal infections. The main symptoms were cough and dyspnea, in 63 (85.1%) patients, pathology on auscultation, in 64 (86.5%) patients, and fever, in 23 (31.1%) patients. Bilateral pathology on X-ray was observed in 34 (45.9%) patients. The most commonly detected pathogens were Streptococcus pneumoniae, in 22 (29.7%) patients, and influenza virus, in 16 (21.6%) patients. The etiology was not established in 23 (31.1%) patients. Third-generation cephalosporins and potentiated aminopenicillin as the most common initial empirical therapies were used in 39 (52.7%) and 20 (27%) patients, respectively. The initial therapy turned out to be effective in 59 (79.7%) patients. Forty-six (62.2%) patients required mechanical ventilation, 40 (54.1%) patients required vasopressors, and 10 (13.5%) patients required the use of renal replacement therapy. The average length of ICU stay was 15.5 days. Forty-seven (63.5%) patients were discharged home, 17 (23%) patients were transferred to long-term care facilities, and 10 (13.5%) patients died.

Conclusions: The study presents the first results characterizing patients with severe community-acquired pneumonia in the Czech Republic. For most indicators, the characteristics of the Czech patients are comparable with the data from other countries, but differences were found in the pneumococcal and influenza vaccine coverage rates, which were low in the Czech Republic. Despite the appropriate empirical antibiotic therapies, severe pneumonia was associated with high mortality and prolonged morbidity.

Keywords: Influenza; Streptococcus pneumoniae; community-acquired pneumonia; influenza; intensive care.