• Jonathan Messika, Annabelle Stoclin, Eric Bouvard, Jean-Pierre Fulgencio, Christophe Ridel, Ioan-Paul Muresan, Jean-Jacques Boffa, Claude Bachmeyer, Michel Denis, Valérie Gounant, Adoracion Esteso, Valeria Loi, Charlotte Verdet, Hélène Prigent, Antoine Parrot, and Muriel Fartoukh.
• Service de Réanimation Médico-Chirurgicale, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France, Service de Réanimation Médico-Chirurgicale, Hôpital Louis Mourier, AP-HP, Colombes, France, Univ Paris Diderot, Sorbonne Paris Cité, IAME, UMRS 1137, Paris, France, and INSERM, IAME, U1137, Paris, France.
• Respir Care. 2016 Feb 1; 61 (2): 225-34.

BackgroundEarly recognition and an attempt at obtaining microbiological documentation are recommended in patients with non-community-acquired pneumonia (NCAP), whether hospital-acquired (HAP) or health care-associated (HCAP). We aimed to characterize the clinical features and microbial etiologies of NCAP to assess the impact of microbiological investigation on their management.MethodsThis was a prospective 1-y study in a university hospital with 141 non-mechanically ventilated subjects suspected of having HAP (n = 110) or HCAP (n = 31).ResultsClinical criteria alone poorly identified pneumonia (misdiagnosis in 50% of cases). Microbiological confirmation was achievable in 80 subjects (57%). Among 79 microorganisms isolated, 28 were multidrug-resistant aerobic Gram-negative bacilli and group III Enterobacteriaceae and 6 were methicillin-resistant Staphylococcus aureus. Multidrug-resistant aerobic Gram-negative bacilli accounted for one third of the microorganisms in early-onset HAP and for 50% in late-onset HAP. Methicillin-resistant S. aureus was most often recovered from subjects with HCAP. Inappropriate empirical antibiotics were administered to 36% of subjects with confirmed pneumonia. Forty subjects were admitted to the ICU, 13 (33%) of whom died. Overall, 39 subjects (28%) died in the hospital.ConclusionsIntegrating the microbiological investigation in the complex clinical diagnostic workup of patients suspected of having NCAP is mandatory. Respiratory tract specimens should be obtained whenever possible for appropriate management.Copyright © 2016 by Daedalus Enterprises.

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