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J Crit Care. 2014 Oct;29(5):733-8. doi: 10.1016/j.jcrc.2014.05.021. Epub 2014 Jun 4.

Risks of nonsteroidal antiinflammatory drugs in undiagnosed intensive care unit pneumococcal pneumonia: younger and more severely affected patients.

Author information

1
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.
2
AP-HP, Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, 178 rue des Renouillers, Colombes, France F-92700.
3
IAME, UMR 1137, INSERM, Paris, France F-75018; IAME, UMR 1137, Univ Paris Diderot, Sorbonne Paris Cité, Paris, France F-75018; AP-HP, Hôpital Louis Mourier, Service de Microbiologie, 178 rue des Renouillers, Colombes, France F-92700.
4
AP-HP, Hôpital Louis Mourier, Service de Microbiologie, 178 rue des Renouillers, Colombes, France F-92700.
5
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. Electronic address: jean-damien.ricard@lmr.aphp.fr.

Abstract

PURPOSE:

The 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 METHODS:

Medical records of ICU adult patients (12-year period) with a pneumococcal CAP diagnosis were retrospectively analyzed according to previous NSAID exposure.

RESULTS:

One 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.

CONCLUSIONS:

We 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.

KEYWORDS:

ICU outcome; Nonsteroidal antiinflammatory drug; Pleural effusion; Streptococcus pneumonia; severe community-acquired pneumonia

PMID:
24997726
DOI:
10.1016/j.jcrc.2014.05.021
[Indexed for MEDLINE]

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