Abstract
Objectives:To explore the risk factors, pathogens and outcomes of severe community-acquired pneumonia (SCAP) in patients with respiratory failure.Methods:A prospective observational study was conducted at Northwest General Hospital & Research Centre, Peshawar, Pakistan from February 2016 to October 2018. All patients with Community-acquired pneumonia (CAP) who fulfilled the inclusion criteria were recorded consecutively. Diagnosis of SCAP was made following the criteria established by the IDSA/ATS in the consensus guidelines on the management of CAP in adults published in 2007. In-hospital mortality was the main outcome.Results:The final analysis comprised a total of 100 patients with SCAP. The mean age was 60.0±18.01 years, and 54.0% were female patients. Afghani patients represented 22.0% of the total patients. The most common comorbidity associated with SCAP was hypertension (42.0%). The most commonly isolated etiological agents were Acinetobacter baumannii, followed by extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli. In-hospital mortality was 45%. On multivariate analysis, factors associated with in-hospital mortality were age (OR 1.054; 95%Cl 1.01-1.10; p=0.021), presence of two or more complications (OR 4.51; 95%Cl 1.18-17.28; p=0.028), septic shock (OR 6.44; 95%Cl 1.55-26.803; p=0.010), length of mechanical ventilation (OR 1.17; 95%Cl 1.01-1.40; p=0.043), and paO2 (OR 4.51; 95%Cl 1.18-17.28; p=0.004).Conclusion:A high mortality rate was observed in our study. Age, presence of two or more complications, septic shock, length of mechanical ventilation, and low paO2 were identified to be independent predictors of mortality for patients with SCAP.
Highlights
Community-acquired pneumonia (CAP) is a frequent and fatal infection
In view of the paucity of data on this subject in Pakistan, we aimed to explore the risk factors, pathogens and outcomes associated with Severe community-acquired pneumonia (SCAP)
Hypertension and chronic obstructive airways disease (COPD) were the most common comorbidities associated with SCAP and present in 42 (42%) and 37 (37%) of the patients respectively
Summary
Community-acquired pneumonia (CAP) is a frequent and fatal infection. Despite breakthroughsCorrespondence: August 12, 2021 December 23, 2021 December 24, 2021 January 8, 2022 in antimicrobial therapy and supportive approaches, CAP lingers on to be a prime concern and contributes to substantial morbidity and mortality globally. Community-acquired pneumonia (CAP) is a frequent and fatal infection. Correspondence: August 12, 2021 December 23, 2021 December 24, 2021 January 8, 2022 in antimicrobial therapy and supportive approaches, CAP lingers on to be a prime concern and contributes to substantial morbidity and mortality globally. Severe community-acquired pneumonia (SCAP) typically necessitates hospitalization and intensive care. SCAP or CAP that requires intensive care unit (ICU) admission portends a noticeably serious prognosis.[1-3]. The severity of illness, certain patient characteristics and co-comorbidities in these patients are typically related to poor prognosis.[4]. SCAP is defined as the presence of acute respiratory failure (ARF) needing supportive therapy and/or septic shock with
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