• Marta Di Pasquale, Miquel Ferrer, Mariano Esperatti, Ernesto Crisafulli, Valeria Giunta, Gianluigi Li Bassi, Mariano Rinaudo, Francesco Blasi, Michael Niederman, and Antoni Torres.
• 1Servei de Pneumologia, Institut del Torax, Hospital Clinic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain. 2Centro de Investigación Biomedica En Red-Enfermedades Respiratorias, Bunyola, Spain. 3Department of Pathophysiology and Transplantation, Università degli Studi di Milano, IRCCS Fondazione Ospedale Maggiore Policlinico Cà Granda, Milano, Italy. 4Department of Pulmonary Rehabilitation, Ospedale Villa Pineta, Pavullo nel Frignano, Modena, Italy. 5Department of Medicine, Winthrop University Hospital, Mineola, NY.
• Crit. Care Med.. 2014 Feb 1;42(2):303-12.

ObjectivesWe evaluated the association between severity of illness and microbial etiology of ICU-acquired pneumonia to define if severity should be used to guide empiric antibiotic choices.DesignProspective observational study.SettingICUs of a university hospital.PatientsThree hundredy forty-three consecutive patients with ICU-acquired pneumonia clustered, according to the presence of multidrug resistant pathogens.InterventionsNone.Measurements And Main ResultsTwo hundred eight patients had ventilator-associated pneumonia and 135 had nonventilator ICU-acquired pneumonia. We determined etiology in 217 patients (63%). The most frequent pathogens were Pseudomonas aeruginosa, Enterobacteriaceae, and methicillin-sensitive and methicillin-resistant Staphylococcus aureus. Fifty-eight patients (17%) had a multidrug-resistant causative agent. Except for a longer ICU stay and a higher rate of microbial persistence at the end of the treatment in the multidrug-resistant group, no differences were found in clinical and inflammatory characteristics, severity criteria, and mortality or survival between patients with and without multidrug-resistant pathogens, even after adjusting for potential confounders. Patients with higher severity scores (Acute Physiology and Chronic Health Evaluation II and Sepsis-related Organ Failure Assessment) and septic shock at onset of pneumonia had significantly lower 28- and 90-day survival and higher systemic inflammatory response. The results were similar when only patients with microbial diagnosis were considered, as well as when stratified into ventilator-associated pneumonia and nonventilator ICU-acquired pneumonia.ConclusionsIn patients with ICU-acquired pneumonia, severity of illness seems not to affect etiology. Risk factors for multidrug resistant, but not severity of illness, should be taken into account in selecting empiric antimicrobial treatment.

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