Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2024 Apr 20;14(1):61.
doi: 10.1186/s13613-024-01287-1.

Microbiological features of drowning-associated pneumonia: a systematic review and meta-analysis

Vladimir L Cousin  1 , Laure F Pittet  2
Affiliations
Review

Microbiological features of drowning-associated pneumonia: a systematic review and meta-analysis

Vladimir L Cousin et al. Ann Intensive Care. .

Abstract

Background: Drowning-associated pneumonia (DAP) is frequent in drowned patients, and possibly increases mortality. A better understanding of the microorganisms causing DAP could improve the adequacy of empirical antimicrobial therapy. We aimed to describe the pooled prevalence of DAP, the microorganisms involved, and the impact of DAP on drowned patients.

Methods: Systematic review and meta-analysis of studies published between 01/2000 and 07/2023 reporting on DAP occurrence and microorganisms involved.

Results: Of 309 unique articles screened, 6 were included, involving 688 patients. All were retrospective cohort studies, with a number of patients ranging from 37 to 270. Studies were conducted in Europe (France N = 3 and Netherland N = 1), United States of America (N = 1) and French West Indies (N = 1). Mortality ranged between 18 to 81%. The pooled prevalence of DAP was 39% (95%CI 29-48), similarly following freshwater (pooled prevalence 44%, 95%CI 36-52) or seawater drowning (pooled prevalence 42%, 95%CI 32-53). DAP did not significantly impact mortality (pooled odds ratio 1.43, 95%CI 0.56-3.67) but this estimation was based on two studies only. Respiratory samplings isolated 171 microorganisms, mostly Gram negative (98/171, 57%) and mainly Aeromonas sp. (20/171, 12%). Gram positive microorganisms represented 38/171 (22%) isolates, mainly Staphylococcus aureus (21/171, 12%). Water salinity levels had a limited impact on the distribution of microorganisms, except for Aeromonas sp. who were exclusively found following freshwater drowning (19/106, 18%) and never following seawater drowning (0%) (p = 0.001). No studies reported multidrug-resistant organisms but nearly 30% of the isolated microorganisms were resistant to amoxicillin-clavulanate, the drug that was the most commonly prescribed empirically for DAP.

Conclusions: DAP are commonly caused by Gram-negative bacteria, especially Aeromonas sp. which is exclusively isolated following freshwater drowning. Empirical antimicrobial therapy should consider covering them, noting than amoxicillin-clavulanate may be inadequate in about one-third of the cases. The impact of DAP on patients' outcome is still unclear.

Keywords: Antibiotic; Drowning associated pneumonia; Intensive care unit; Pneumonia; Resistance.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Preferred reporting items for systematic reviews and meta-analyses flow diagram
Fig. 2
Fig. 2
Forrest plot of included studies reporting prevalence of drowning associated pneumonia DAP drowning associated pneumonia
Fig. 3
Fig. 3
Forrest plot of included studies reporting impact of DAP on patients’ mortality rate DAP drowning associated pneumonia; Surv survivor
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Szpilman D, Bierens JJ, Handley AJ, Orlowski JP. Drowning. N Engl J Med. 2012;366(22):2102–2110. doi: 10.1056/NEJMra1013317. - DOI - PubMed
    1. Reizine F, Delbove A, Tattevin P, Santos AD, Bodenes L, Bouju P, et al. Clinical and microbiological features of drowning-associated pneumonia: a retrospective multicentre cohort study. Clin Microbiol Infect. 2023 doi: 10.1016/j.cmi.2022.07.027. - DOI - PubMed
    1. Robert A, Danin PE, Quintard H, Degand N, Martis N, Doyen D, et al. Seawater drowning-associated pneumonia: a 10-year descriptive cohort in intensive care unit. Ann Intensive Care. 2017;7(1):45. doi: 10.1186/s13613-017-0267-4. - DOI - PMC - PubMed
    1. van Berkel M, Bierens JJ, Lie RL, de Rooy TP, Kool LJ, van de Velde EA, et al. Pulmonary oedema, pneumonia and mortality in submersion victims; a retrospective study in 125 patients. Intensive Care Med. 1996;22(2):101–107. doi: 10.1007/BF01720715. - DOI - PubMed
    1. Gregorakos L, Markou N, Psalida V, Kanakaki M, Alexopoulou A, Sotiriou E, et al. Near-drowning: clinical course of lung injury in adults. Lung. 2009;187(2):93–97. doi: 10.1007/s00408-008-9132-4. - DOI - PubMed

LinkOut - more resources