CAP death: what goes wrong when everything is right?

Abstract

Community-acquired pneumonia is the leading cause of infectious death in USA 1 Kochanek KD Murphy SL Xu J Arias E Mortality in the United States, 2013. NCHS Data Brief. 2014; 178: 1-8 PubMed Google Scholar and throughout the world. 2 World Health OrganizationThe top 10 causes of death. http://www.who.int/mediacentre/factsheets/fs310/en/index.html Google Scholar Delay in appropriate antibiotic therapy is associated with increased mortality in community-acquired pneumonia, 3 Houck PM Bratzler DW Nsa W Ma A Bartlett JG Timing of antibiotic administration and outcomes for Medicare patients hospitalized with community-acquired pneumonia. Arch Intern Med. 2004; 164: 637-644 Crossref PubMed Scopus (620) Google Scholar and complications of community-acquired pneumonia such as septic shock, 4 Kumar A Haery C Paladugu B et al. The duration of hypotension before the initiation of antibiotic treatment is a critical determinant of survival in a murine model of Escherichia coli septic shock: association with serum lactate and inflammatory cytokine levels. J Infect Dis. 2006; 193: 251-258 Crossref PubMed Scopus (156) Google Scholar acute respiratory distress syndrome, 5 Kojicic M Li G Hanson AC et al. Risk factors for the development of acute lung injury in patients with infectious pneumonia. Crit Care. 2012; 16: R46 Crossref PubMed Scopus (36) Google Scholar , 6 Iscimen R Cartin-Ceba R Yilmaz M et al. Risk factors for the development of acute lung injury in patients with septic shock: an observational cohort study. Crit Care Med. 2008; 36: 1518-1522 Crossref PubMed Scopus (176) Google Scholar and acute kidney injury. 7 Plataki M Kashani K Cabello-Garza J et al. Predictors of acute kidney injury in septic shock patients: an observational cohort study. Clin J Am Soc Nephrol. 2011; 6: 1744-1751 Crossref PubMed Scopus (131) Google Scholar The improvements in mortality rates reported over the past decade for each of these infection-related organ failure syndromes might be substantially related to increasing emphasis on rapid provision of appropriate antibiotics. Risk factors for 30-day mortality in patients with pneumonia who receive appropriate initial antibiotics: an observational cohort studyPatients with two or more risk factors were at a higher risk of death during the 30 days assessed than were individuals with no or one risk factor, despite appropriate initial antibiotic treatment. Therefore, adjunctive therapy might be important for improving outcomes in patients with two or more risk factors. Full-Text PDF