• Jonathan Messika, Benjamin Sztrymf, Fabrice Bertrand, Typhaine Billard-Pomares, Guilene Barnaud, Catherine Branger, Didier Dreyfuss, and Jean-Damien Ricard.
• AP-HP, Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, 178 rue des Renouillers, Colombes, France F-92700; IAME, UMR 1137, INSERM, Paris, France F-75018; IAME, UMR 1137, Univ Paris Diderot, Sorbonne Paris Cité, Paris, France F-75018.
• J Crit Care. 2014 Oct 1;29(5):733-8.

PurposeThe purpose of this study is to investigate whether exposure to nonsteroidal antiinflammatory drugs (NSAIDs) at the early stage of severe pneumococcal community-acquired pneumonia (CAP) requiring intensive care unit (ICU) admission may affect its presentation and outcome.Material And MethodsMedical records of ICU adult patients (12-year period) with a pneumococcal CAP diagnosis were retrospectively analyzed according to previous NSAID exposure.ResultsOne hundred six confirmed pneumococcal CAP were identified, 20 received NSAIDs within 4 (2-6) days before admission. Nonsteroidal antiinflammatory drug-exposed patients were younger (43.3 vs 62.2 years; P < .0001), had less frequently at least one chronic comorbid condition (40% vs 75%; P = .003), had more often complicated pleural effusions (20% vs 2.3%; P = .01), and more frequent pleuropulmonary complications (odds ratio: 5.75 [1.97-16.76]). Nonsteroidal antiinflammatory drug patients required more often noninvasive ventilatory support (25% vs 4.6%; P = .003). Intensive care unit length of stay and mortality were similar.ConclusionsWe report as severe pneumococcal pneumonia in young and healthy patients exposed to NSAIDs as in older, more comorbid, and nonexposed ones. Nonsteroidal antiinflammatory drug use may mask initial symptoms and delay antimicrobial therapy, thus predisposing to worse outcomes.Copyright © 2014 Elsevier Inc. All rights reserved.

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