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.

Details

Title
Severe atypical pneumonia in critically ill patients: a retrospective multicenter study
Author
Valade, S 1 ; Biard, L 2 ; Lemiale, V 1 ; Argaud, L 3 ; Pène, F 4 ; Papazian, L 5 ; Bruneel, F 6 ; Seguin, A 7 ; Kouatchet, A 8 ; Oziel, J 9 ; Rouleau, S 10 ; Bele, N 11 ; Razazi, K 12 ; Lesieur, O 13 ; Boissier, F 14 ; Megarbane, B 15 ; Bigé, N 16 ; Brulé, N 17 ; Moreau, A S 18 ; Lautrette, A 19 ; Peyrony, O 20 ; Perez, P 21 ; Mayaux, J 22 ; Azoulay, E 1 

 AP-HP, Medical ICU, Hôpital Saint-Louis, Paris, France; UFR de Médecine, University Paris-7 Paris-Diderot, Paris, France 
 UFR de Médecine, University Paris-7 Paris-Diderot, Paris, France; AP-HP, DBIM, Hôpital Saint-Louis, Paris, France 
 Hôpital Edouard Herriot, Service de Réanimation Médicale, Hospices Civils de Lyon, Lyon, France 
 AP-HP, Réanimation médicale, Hôpital Cochin, Paris, France 
 Réanimation des Détresses Respiratoires et Infections Sévères, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Marseille, France 
 Service de Réanimation, Centre Hospitalier de Versailles, Le Chesnay, France 
 Department of Medical Intensive Care, CHU de Caen, Caen, France 
 Service de Réanimation Médicale et Médecine Hyperbare, Hôpital Angers, Angers, France 
 AP-HP, Medical-Surgical Intensive Care Unit, Avicenne University Hospital, Bobigny, France 
10  Service de Réanimation polyvalente, Angoulême, France 
11  Intensive Care Unit, Draguignan Hospital, Draguignan, France 
12  AP-HP, Groupe Henri Mondor-Albert Chenevier, Service de Réanimation Médicale, Hôpital Henri Mondor, Créteil, France 
13  Service de Réanimation, CH Saint-Louis, La Rochelle, France 
14  AP-HP, Réanimation médicale, Hôpital Européen Georges Pompidou, Paris, France 
15  AP-HP, Department of Medical and Toxicological Critical Care, Lariboisière Hospital, Paris, France 
16  AP-HP, Medical Intensive Care Unit, Hôpital Saint-Antoine, Paris, France 
17  Medical Intensive Care Unit, Centre Hospitalier Universitaire de Nantes, Nantes, France 
18  Centre de réanimation, Hôpital Salengro, CHU-Lille, Lille, France 
19  Service de Réanimation Médicale Polyvalente, CHU Gabriel Montpied, Clermont-Ferrand, France 
20  AP-HP, Service des urgences, Hôpital Saint-Louis, Paris, France 
21  Service de Réanimation médicale, Hôpital Brabois, Nancy, France 
22  AP-HP, Pneumology and Critical Care Medicine Department, Universitary Hospital La Pitié Salpêtrière-Charles Foix, Paris, France 
Pages
1-9
Publication year
2018
Publication date
Aug 2018
Publisher
Springer Nature B.V.
e-ISSN
21105820
Source type
Scholarly Journal
Language of publication
English
ProQuest document ID
2087937461
Copyright
Annals of Intensive Care is a copyright of Springer, (2018). All Rights Reserved., © 2018. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.