Source: Annual Congress 2002 - Clinical aspects of antibiotic and nonantibiotic therapy of pneumonia in the ICU
Disease area: Respiratory critical care, Respiratory infections

Abstract

A prospective study with a period of one year included 71 immunocompetent patients with clinical suspicion of nosocomial pneumonia. Microbial investigation of the respiratory secretions, blood and urine, and cytokine measurements were performed the day of the diagnosis (day 1) and after 72 h of empirical antibiotic treatment (day 3). The definition of non-response (NR) included at least one of the following: persistence of fever and purulent respiratory secretions; worsening of the pulmonary; occurrence of septic shock or multiple organ dysfunction syndrome; death.
43 patients (61%) fulfilled the criteria of non-response and the aetiology of failure could be determined in 65% cases: inappropriate treatment (32%), superinfection (18%), concomitant infectious focus (39%), non-infectious cause (29%). The predictors for treatment failure were: intubation for nosocomial pneumonia (p=0.038) and high serum IL-6 at day 1 (p=0.042). The predictors for the hospital mortality were: change of the endotracheal tube (p=0.05), high serum TNF-a at day 3 (p=0.02) and high serum IL-6 at day 3 (p=0.03).
Conclusion: The most frequent causes of non-response were the inappropriate antibiotic treatment and a concomitant focus of infection. IL-6 was the most powerful predictor for both failure of treatment and mortality in ICU-acquired pneumonia.

Rating:

Share or cite this content

Citations should be made in the following way:
M. Ioanas, R. Ferrer, M. Ferrer, S. Ewig, J. Angrill, A. Rano, A. de Roux, C. Agusti, P. de la Bellacasa, A. Torres (Bucharest, Romania; Sabadell, Barcelona, Spain; Bonn, Germany). Causes and predictors of treatment failures in patients with ICU-acquired pneumonia. Eur Respir J 2002; 20: Suppl. 38, 234

Member's Comments

No comment yet.

Related content which might interest you: Prediction of complications development and lethal outcome in patients with community-acquired pneumonia Source: Annual Congress 2011 - The new clinical spectrum of lung diseases: from bronchi to pleura Year: 2011 Predictors of mortality for patients with COVID-19 pneumonia caused by SARS-CoV-2 Source: Eur Respir J, 56 (3) 2002961; 10.1183/13993003.02961-2020 Year: 2020 Predictors of mortality for patients with COVID-19 pneumonia caused by SARS-CoV-2 Source: Eur Respir J, 56 (3) 2002439; 10.1183/13993003.02439-2020 Year: 2020 Biomarkers as complication predictors in community-acquired pneumonia Source: Annual Congress 2011 - Biomarkers and outcomes of community-acquired pneumonia Year: 2011 Predictive factors of in-hospital mortality of patients with community-acquired pneumonia Source: Eur Respir J 2006; 28: Suppl. 50, 352s Year: 2006 The impact of comorbidities on the in-hospital mortality in patients with community-acquired pneumonia Source: International Congress 2015 – Pneumonia: determinants of clinical outcomes and potential strategies to improve its management Year: 2015 Impact of nosocomial pneumonia on the outcome of mechanically-ventilated patients Source: Eur Respir J 2004; 24: Suppl. 48, 548s Year: 2004 Impact of macrolide therapy on mortality for patients with severe sepsis due to pneumonia Source: Eur Respir J 2009; 33: 153-159 Year: 2009 Risk factors for early onset severe community-acquired pneumonia complications Source: International Congress 2018 – Pleural diseases and pneumonia: what's new ? Year: 2018 Predictors of rehospitalization after admission for community-acquired pneumonia Source: Annual Congress 2012 - Epidemiology: risk factors and prognosis in respiratory infections Year: 2012 Incidence of severe sepsis as a cause of clinical failure in patients with community-acquired pneumonia (CAP) Source: Eur Respir J 2007; 30: Suppl. 51, 42s Year: 2007 Incidence, risk factors and outcomes of cardiovascular events in hospitalized patients with community-acquired pneumonia (CAP) Source: Annual Congress 2009 - Complications of respiratory infections: impact of comorbidities and infections caused by Aspergillus Year: 2009 Predictors of treatment failure in patients with bacteremic pneumococcal community-acquired pneumonia Source: Annual Congress 2013 –Pneumonia and sepsis Year: 2013 Role of procalcitonin in predicting severity and in-hospital mortality in patients with community-acquired pneumonia Source: International Congress 2016 – Community-acquired pneumonia: risk classes and management issues Year: 2016 Steroids are not associated with an improvement in clinical outcomes in hospitalized patients with community-acquired pneumonia (CAP) Source: Annual Congress 2009 - Treatment and prevention of lower respiratory tract infections Year: 2009 Macrolide therapy is associated with lower 30-day mortality in patients with non-pneumonia and pneumonia severe sepsis Source: Annual Congress 2011 - Antimicrobial treatment and resistance in lower respiratory tract infections Year: 2011 Risk factors of nosocomial pneumonia in multiple trauma patients Source: International Congress 2018 – Pneumonia: from the community to the intensive care unit Year: 2018 Validation of treatment failure criteria of nosocomial pneumonia in ICU Source: Annual Congress 2011 - Intensive care outcome Year: 2011 On improving assessment of in-hospital mortality and ICU admisison in community-acquired pneumonia patients by using the e-CURB Source: Annual Congress 2012 - Respiratory infections: prognosis and outcome Year: 2012 Risk contribution of comorbidities in hospitalized patients with Covid 19 pneumonia Source: Virtual Congress 2021 – COVID - 19 epidemiology Year: 2021