Pneumonia presenting with organ dysfunctions: Causative microorganisms, host factors and outcome

Autores de IIS La Fe

• Rosario Menéndez Villanueva

  Autor

• Beatriz Montull Veiga

  Autor

• Soledad Reyes Calzada

  Autor

• Isabel Emilia Amara Elori

  Autor

• Rafael Zalacain Jorge

  Autor

• Javier Aspa Marco

  Autor

• Luis Borderias Clau

  Autor

• Juan Jose Martin Villasclaras

  Autor

• Salvador Bello Dondra

  Autor

• Inmaculada Alfageme Michavilla

  Autor

• Felipe Rodriguez De Castro

  Autor

• Jordi Rello Condomines

  Autor

• Luis Molinos Martin

  Autor

• Juan Ruiz Manzano

  Autor

• Antonio Torres Marti

  Autor

Participantes ajenos a IIS La Fe

• Capelastegui A

Grupos

• Infecciones Respiratorias

  Investigador Principal

  Raúl Méndez Ocaña

Abstract

Community-acquired pneumonia (CAP) is a serious infection that may occasionally rapidly evolve provoking organ dysfunctions. We aimed to characterize CAP presenting with organ dysfunctions at the emergency room, with regard to host factors and causative microorganisms, and its impact on 30-day mortality. 460 of 4070 (11.3%) CAP patients had >= 2 dysfunctions at diagnosis, with a 30-day mortality of 12.4% vs. 3.4% in those with one or no dysfunctions. Among them, the most frequent causative microorganisms were Streptococcus pneumoniae, gram-negatives and polymicrobial etiology. Independent host risk factors for presenting with >= 2 dysfunctions were: liver (OR 2.97) and renal diseases (OR 3.91), neurological disorders (OR 1.86), and COPD (OR 1.30). Methicillin-resistant Staphylococcus aureus (OR 6.41) and bacteraemic episodes (OR 1.68) had the higher independent risk among microorganisms. The number of organ dysfunctions vs. none increased at 30-day mortality: three organs (OR 11.73), two organs (OR 4.29), and one organ (OR 2.42) whereas Enterobacteria (OR 3.73) were also independently related to mortality. The number of organ dysfunctions was the strongest 30-day mortality risk factor while Enterobacteriaceae was also associated with poorer outcome. The assessment of organ dysfunctions in CAP should be implemented for management, allocation and treatment decisions on initial evaluation. (C) 2016 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

Keywords

• Community-acquired pneumonia; Organ dysfunction; Risk factors; Comorbidity; Mortality