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Epidemiology and risk factors of pneumonia in critically ill patients

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Abstract

Risk factors for pneumonia were analysed in a large population of critically ill patients, collected in two prospective multicentre “pneumonia studies” in Italy. Twenty-three intensive care units were involved and the study time was 150 unit months. Only patients without previous pulmonary infection, with intensive care unit stay ≥ 48 hours and no rapidly irreversible illness at admission were included. The incidence of pneumonia in the 1475 selected patients was 15% (220 cases). 239 patients died in ICU; the mortality rate was significantly higher in patients developing pneumonia (p<0.0001); pneumonia was found to be an independent highly significant risk factor for death in critically ill patients (OR = 3.88; p<0.0001).

Multivariate analysis of seven risk factors for pneumonia showed a significantly higher risk in patients with neuromuscular disease (OR = 3.8, p<0.002), impairment of airway reflexes at admission (OR = 2.93, p<0.0001), and ≥ 24h respiratory assistance (OR=3.05, p<0.0001). Impairment of airway reflexes at admission to the emergency room or intensive care unit identifies the population who will experience 3/4 of the overall lower respiratory tract infections.

Rapid recognition of at-risk patients seems clinically important and may improve awareness programs and preventive approaches.

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Authors and Affiliations

  1. Istituto Ricerche Farmacologiche “Mario Negri”, Milano, Italy

    P. Mosconi & M. Mandelli

  2. Istituto di Anestesia e Rianimazione, Ospedale Maggiore di Milano, Via Francesco Sforza, 35, 20122, Milano, Italy

    M. Langer & M. Cigada

Authors
  1. P. Mosconi
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  2. M. Langer
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  3. M. Cigada
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  4. M. Mandelli
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Intensive Care Unit Group for Infection Control (I.C.U.G.I.C.), a list of participating physician co-authors of the paper is reported at the end

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Mosconi, P., Langer, M., Cigada, M. et al. Epidemiology and risk factors of pneumonia in critically ill patients. Eur J Epidemiol 7, 320–327 (1991). https://doi.org/10.1007/BF00144995

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