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Open Access Research article

Improvement in process of care and outcome in patients requiring intensive care unit admission for community acquired pneumonia

Hugues Georges13*, Cécile Journaux1, Patrick Devos2, Serge Alfandari1, Pierre Yves Delannoy1, Agnès Meybeck1, Arnaud Chiche1, Nicolas Boussekey1 and Olivier Leroy1

Author Affiliations

1 Intensive Care Unit, Hôpital chatiliez, 135 rue du Président Coty, BP 619, 59208, Tourcoing, cedex, France

2 Department of Biostatistics, Centre Hospitalier Universitaire de Lille, 59000, Lille, France

3 Service de réanimation médicale, Hôpital chatiliez, 135 rue du Président Coty, BP 619, 59208, Tourcoing, cedex, France

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BMC Infectious Diseases 2013, 13:196  doi:10.1186/1471-2334-13-196

Published: 30 April 2013

Abstract

Background

The present study was performed to assess the prognosis of patients admitted to the intensive care unit (ICU) for community acquired pneumonia (CAP) after implementation of new processes of care.

Methods

Two groups of patients with CAP were admitted to a 16-bed multidisciplinary ICU in an urban teaching hospital during two different periods: the years 1995–2000, corresponding to the historical group; and 2005–2010, corresponding to the intervention group. New therapeutic procedures were implemented during the period 2005–2010. These procedures included a sepsis management bundle derived from the Surviving Sepsis Campaign, use of a third-generation cephalosporin and levofloxacin as the initial empirical antimicrobial regimen, and noninvasive mechanical ventilation following extubation.

Results

A total of 317 patients were studied: 142 (44.8%) during the historical period and 175 (55.2%) during the intervention period. Sequential Organ Failure Assessment scores were higher in patients in the intervention group (7.2 ± 3.7 vs 6.2 ± 2.8; p=0.008). Mortality changed significantly between the two studied periods, decreasing from 43.6% in the historical group to 30.9% in the intervention group (p < 0.02). A restrictive transfusion strategy, use of systematic postextubation noninvasive mechanical ventilation in patients with severe chronic respiratory or cardiac failure patients, less frequent use of dobutamine and/or epinephrine in patients with sepsis or septic shock, and delivery of a third-generation cephalosporin associated with levofloxacin as empirical antimicrobial therapy were independently associated with better outcomes.

Conclusion

Positive outcomes in ICU patients with CAP have significantly increased in our ICU in recent years. Many new interventions have contributed to this improvement.

Keywords:
Severe community acquired pneumonia; Intensive care unit; Antimicrobial therapy; Combination therapy