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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.
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Details
1 AP-HP, Medical ICU, Hôpital Saint-Louis, Paris, France; UFR de Médecine, University Paris-7 Paris-Diderot, Paris, France
2 UFR de Médecine, University Paris-7 Paris-Diderot, Paris, France; AP-HP, DBIM, Hôpital Saint-Louis, Paris, France
3 Hôpital Edouard Herriot, Service de Réanimation Médicale, Hospices Civils de Lyon, Lyon, France
4 AP-HP, Réanimation médicale, Hôpital Cochin, Paris, France
5 Réanimation des Détresses Respiratoires et Infections Sévères, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Marseille, France
6 Service de Réanimation, Centre Hospitalier de Versailles, Le Chesnay, France
7 Department of Medical Intensive Care, CHU de Caen, Caen, France
8 Service de Réanimation Médicale et Médecine Hyperbare, Hôpital Angers, Angers, France
9 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