Survival in patients with nosocomial pneumonia: Impact of the severity of illness and the etiologic agent

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Abstract

Objective

To assess the impact of severity of illness at different times, using the Mortality Probability Models (MPM II), and the impact of etiologic agent on survival in patients with nosocomial pneumonia.

Design

Retrospective, observational study.

Setting

Fourteen-bed medical-surgical intensive care unit (ICU) in a teaching hospital.

Patients

Sixty-two patients with nosocomial pneumonia who were receiving early appropriate antibiotic treatment.

Interventions

None.

Measurements and Main Results

Severity of illness at the time of admission to the ICU (M0), 24 hrs after admission (M24), and at the time of pneumonia diagnosis (M1) was determined using MPM II. Bacteriology was established by quantitative cultures from bronchoscopic samples. The outcome measure was the crude mortality rate.

Conclusions

Severity of illness when pneumonia is diagnosed is the most important predictor of survival, and this determination should be used for therapeutic and prognostic stratification. In addition, the presence of P. aeruginosa contributed to an excess of mortality that could not be measured by MPM II alone, suggesting the importance of the pathogen in prognosis. (Crit Care Med 1997; 25:1862-1867)

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