Risk factors for slowly resolving pneumonia in the intensive care unit

Background: Slowly resolving pneumonia (SRP) poses early challenges for identification and medical expense for clinicians in intensive care units (ICUs); to date, the literature has been very limited in this regard. Methods: This was a retrospective and cohort-based study in the ICU of a university-affiliated hospital in Shanghai. Medical records of pneumonia patients in the ICU between April 2008 and February 2011 were reviewed retrospectively to evaluate the risk factors for SRP. Results: In all, 106 pneumonia patients in the ICU were identified as immune-competent with a diagnosis of bacterial pneumonia. There were 62 (58.49%) patients who showed SRP and their radiographic infiltrations were completely resolved between 5 weeks and 8 weeks. Multivariate logistic regression analysis demonstrated that initial treatment with an inappropriate antibiotic, multilobar infiltration, and a high CURB-65 score were independent risk factors for SRP, with odds ratio (OR) values of 8.338 [95% confidence interval (CI) 2.117-32.848], 11.184 (95% CI 2.526-49.514), and 2.329 (95% CI 1.172-4.626), respectively. The length of the ICU stay in the SRP group was twice as long as that of the normally resolving pneumonia (NRP) group (62.27 +/- 73.73 vs. 32.25 +/- 23, p = 0.002). The 28-day and 60-day mortality rates in the SRP group were 17.74% and 25.81%, respectively. In addition, the 60-day mortality rate was significantly higher in the SRP group than the NRP group (25.81% vs. 6.82%, respectively; p = 0.012). Moreover, SRP was an independent risk factor for 60-day mortality (OR 5.687, 95% CI 1.334=24.240). Conclusion: Treatment with an inappropriate antibiotic, multilobar infiltration, and a high CURB-65 score were independent risk factors for SRP. Copyright (C) 2014, Taiwan Society of Microbiology. Published by Elsevier Taiwan LLC. This is an open access article under the CC BY-NC-ND license.