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Published on: June 24, 2019
Severe atypical pneumonia in critically ill patients: a retrospective multicenter study
S Valade1,2, L Biard3,4, V Lemiale5,3
1AP-HP, Medical ICU, Hôpital Saint-Louis, 1 Avenue Claude Vellefaux, 75010, Paris, France. sandrine.valade@aphp.fr.
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.
Insights
Atypical pneumonia due to Mycoplasma pneumoniae (MP) or Chlamydophila pneumoniae (CP) can lead to severe respiratory failure requiring intensive care. This study found MP pneumonia had lower mortality than Streptococcus pneumoniae pneumonia, with distinct clinical features.
Area of Science:
- Infectious Diseases
- Pulmonology
- Critical Care Medicine
Background:
- Atypical bacterial pneumonia, including Chlamydophila pneumoniae (CP) and Mycoplasma pneumoniae (MP), is a significant cause of acute respiratory failure necessitating intensive care unit (ICU) admission.
- Understanding the clinical spectrum and outcomes of these infections is crucial for effective management.
Purpose of the Study:
- To describe the characteristics of patients with atypical pneumonia admitted to the ICU.
- To compare the clinical, radiographic, and outcome differences between Mycoplasma pneumoniae (MP) and Streptococcus pneumoniae (SP) pneumonia in the ICU setting.
Main Methods:
- A retrospective descriptive study of adult patients with proven atypical pneumonia admitted to 20 French ICUs between 2000 and 2015.
- Comparison of patients with MP pneumonia against those with SP pneumonia using statistical analysis, including MCA.
Main Results:
- Out of 104 patients, 73% had MP and 27% had CP pneumonia. Co-infections were noted in 47% of cases.
- MP pneumonia patients exhibited more interstitial pneumonia and fewer pleural effusions compared to SP pneumonia patients.
- Overall ICU mortality was 11%, with MP pneumonia showing a significantly lower mortality rate (8%) than SP pneumonia (22%).
Conclusions:
- Atypical bacterial pneumonia requiring ICU admission has an 11% mortality rate.
- Distinct clinical, laboratory, and radiographic features can help differentiate MP/CP pneumonia from SP pneumonia, aiding in early diagnosis and treatment.
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