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

Annals of Intensive Care

B. Megarbane¹  K. Razazi²  S. Valade³  E. Azoulay³  V. Lemiale³  N. Bigé⁴  J. Oziel⁵  J. Mayaux⁶  F. Pène⁷  F. Boissier⁸  O. Peyrony⁹  A. S. Moreau^1,10  A. Seguin^1,11  L. Argaud^1,12  N. Bele^1,13  N. Brulé^1,14  L. Papazian^1,15  A. Lautrette^1,16  A. Kouatchet^1,17  P. Perez^1,18  S. Rouleau^1,19  O. Lesieur^2,20  F. Bruneel^2,21  L. Biard^2,22 

[1] AP-HP, Department of Medical and Toxicological Critical Care, Lariboisière Hospital;AP-HP, Groupe Henri Mondor-Albert Chenevier, Service de Réanimation Médicale, Hôpital Henri Mondor;AP-HP, Medical ICU, Hôpital Saint-Louis;AP-HP, Medical Intensive Care Unit, Hôpital Saint-Antoine;AP-HP, Medical-Surgical Intensive Care Unit, Avicenne University Hospital;AP-HP, Pneumology and Critical Care Medicine Department, Universitary Hospital La Pitié Salpêtrière-Charles Foix;AP-HP, Réanimation médicale, Hôpital Cochin;AP-HP, Réanimation médicale, Hôpital Européen Georges Pompidou;AP-HP, Service des urgences, Hôpital Saint-Louis;Centre de réanimation, Hôpital Salengro, CHU-Lille;Department of Medical Intensive Care, CHU de Caen;Hôpital Edouard Herriot, Service de Réanimation Médicale, Hospices Civils de Lyon;Intensive Care Unit, Draguignan Hospital;Medical Intensive Care Unit, Centre Hospitalier Universitaire de Nantes;Réanimation des Détresses Respiratoires et Infections Sévères, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord;Service de Réanimation Médicale Polyvalente, CHU Gabriel Montpied;Service de Réanimation Médicale et Médecine Hyperbare, Hôpital Angers;Service de Réanimation médicale, Hôpital Brabois;Service de Réanimation polyvalente;Service de Réanimation, CH Saint-Louis;Service de Réanimation, Centre Hospitalier de Versailles;UFR de Médecine, University Paris-7 Paris-Diderot;

关键词: Pneumonia;    Outcome;    ICU;    Mycoplasma pneumoniae;    Chlamydophila pneumoniae;   

DOI  :  10.1186/s13613-018-0429-z

来源: DOAJ

【 摘 要 】

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.

【 授权许可】

Unknown