Abstract
BackgroundChlamydophila pneumoniae (CP) and Mycoplasma pneumoniae (MP) patients could require intensive care unit (ICU) admission for acute respiratory failure.MethodsAdults admitted between 2000 and 2015 to 20 French ICUs with proven atypical pneumonia were retrospectively described. Patients with MP were compared to Streptococcus pneumoniae (SP) pneumonia patients admitted to ICUs.ResultsA total of 104 patients were included, 71 men and 33 women, with a median age of 56 [44–67] years. MP was the causative agent for 76 (73%) patients and CP for 28 (27%) patients. Co-infection was documented for 18 patients (viruses for 8 [47%] patients). Median number of involved quadrants on chest X-ray was 2 [1–4], with alveolar opacities (n = 61, 75%), interstitial opacities (n = 32, 40%). Extra-pulmonary manifestations were present in 34 (33%) patients. Mechanical ventilation was required for 75 (72%) patients and vasopressors for 41 (39%) patients. ICU length of stay was 16.5 [9.5–30.5] days, and 11 (11%) patients died in the ICU. Compared with SP patients, MP patients had more extensive interstitial pneumonia, fewer pleural effusion, and a lower mortality rate [6 (8%) vs. 17 (22%), p = 0.013]. According MCA analysis, some characteristics at admission could discriminate MP and SP. MP was more often associated with hemolytic anemia, abdominal manifestations, and extensive chest radiograph abnormalities. SP-P was associated with shock, confusion, focal crackles, and focal consolidation.ConclusionIn this descriptive study of atypical bacterial pneumonia requiring ICU admission, mortality was 11%. The comparison with SP pneumonia identified clinical, laboratory, and radiographic features that may suggest MP or CP pneumonia.
Highlights
Chlamydophila pneumoniae (CP) and Mycoplasma pneumoniae (MP) patients could require intensive care unit (ICU) admission for acute respiratory failure
Acute respiratory failure was the main reason for ICU admission (n = 96; 92%); other reasons were cardiovascular failure (n = 2), neurological disorders (n = 3), and miscellaneous reasons (n = 3)
Our descriptive data may be useful to help clinicians to discriminate Streptococcus pneumoniae (SP)-related pneumonia and MP-related pneumonia, even if a double antibiotherapy active against atypical pathogens is recommended in severe patients
Summary
Chlamydophila pneumoniae (CP) and Mycoplasma pneumoniae (MP) patients could require intensive care unit (ICU) admission for acute respiratory failure. Severe pneumonia remains the major reasons for admission to the intensive care unit (ICU), mainly related to Streptococcus pneumoniae (SP). In previous non-ICU studies, compared to bacterial pneumonia, AP was associated with younger age and fewer comorbidities, a lower risk of severe respiratory failure, and better outcome [4, 6, 13, 14, 18]. For patients admitted to ICU, studies remained rare. Our secondary objective was to compare the diagnostic strategy and outcomes between Mycoplasma pneumoniae-related pneumonia (MP) and Streptococcus pneumoniae-related pneumonia (SP) admitted to ICU
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