[Change of prognosis and pathogens in adult patients with severe community-acquired pneumonia during different periods].

ABSTRACT

Objective: To compare the change of prognosis and pathogens of adult patients with severe community-acquired pneumonia (CAP) requiring admission to Respiratory Intensive Care Unit (RICU) during different period, and estimate the risk factors of severe CAP. Methods: The clinical data of 186 patients with severe CAP admission to RICU was collected and assessed the trend in outcomes of these patients during three time periods Period Ⅰ (January 1 2000 to October 31 2006), Period Ⅱ (November 1 2006 to December 31 2010), and Period Ⅲ (January 1 2011 to December 31 2015), analyzed the risk factors by Cox Proportional Hazards regression, and compared the pathogens detection. Results: The total mortality was 34.9%(65/186)during 16 years, three periods was 41.4%, 35.3% and 27.7% respectively.After adjustment for other variables, the mortality was significant higher for patients admitted during Period Ⅰ than that of Period Ⅲ (HR 1.900; 95.0%CI 1.053-3.429, P=0.033), and no significant difference for Period Ⅰ compared with Period Ⅱ (HR 1.394; 95.0%CI 0.774-2.514, P=0.269), Period Ⅱ compared with Period Ⅲ(HR 1.379; 95.0%CI 0.800-2.375, P=0.248). Cox regression analysis showed the predicting risk factors for prognosis including BUN≥7.14 mmol/L, acute heart failure, acute renal failure, multilobar infiltrates and septic infectious shock ( P<0.05). Multi-variate Cox regression analysis showed that multilobar infiltrates(HR=3.951, 95.0%CI 2.252-6.929, P=0.001) and septic infectious shock(HR=2.044, 95.0%CI 1.131-3.692, P=0.018) were the independent risk factors for prognosis.104 (55.9%) were detected pathogens in 186 patients.The common pathogens were Staphylococcus aureus (18 isolated strains), Legionella pneumophila (16 isolated strains), Streptococcus pneumonia (13 isolated strains). There was no significant difference between bacterial isolation except virus detection(P=0.033). Conclusion: There has been an improvement in the prognosis of severe CAP.Multilobar infiltrates and septic infectious shock were the independent risk factors for prognosis.Pathogens had changed in SCAP over time, and the detection rate of virus increased gradually.