Risk Factors for Recurrent Episodes of Suspected Pneumonia

Background: Pneumonia remains the most common intensive care unit (ICU)-acquired infection with patients often suffering multiple episodes. The diagnosis remains difficult as many non-infectious causes can masquerade as pneumonia. The purpose of this study is to identify risk factors for potential recurrent pneumonia from a recent randomized trial. Methods: We performed a retrospective analysis of the recent Trial of Antibiotic Restraint in Presumed Pneumonia (TARPP), which was a multicenter trial of antibiotic initiation strategies. Demographics, comorbidities, and outcomes were reviewed. Standard uni-variable statistical analysis was performed. Results: TARPP enrolled 186 patients with 47 patients (25.3%) having at least one additional episode of suspected pneumonia. Patients with recurrent episodes of suspected pneumonia were more likely to identify as Hispanic or Latino or to speak Spanish as their primary language. Patients with recurrent suspected episodes had longer ICU length of stay, total days of antibiotic agents, and longer ventilator days. Patients with recurrent episodes had a greater overall of culture positivity, but no difference in the rate of infection because of non-fermenting gram-negatives. Patients with recurrent episodes had lower mortality rates overall compared with those with a single infectious episode. Conclusions: This retrospective analysis suggests that ethnicity and language barriers may be associated with recurrent suspected pneumonia. Although greater rate of culture positivity was associated potential recurrence, the lower mortality rates in this group suggest a survivorship bias. More work is needed to evaluate the risks for recurrent pneumonia in the ICU.