Severe Pneumonia: Etiology and Outcome in a Tertiary Hospital in Indonesia

Abstract

Background: Severe pneumonia represents a subset of life-threatening pneumonia. The mortality rate of
patients with severe pneumonia is considerably high. This study aims to determine the etiology and outcome
of severe pneumonia.
Methods: An observational prospective study was conducted from September 2017 to September 2018 on
pneumonia patients in a tertiary hospital. Clinical and diagnostic evaluations were carried out to assess the
severity of the disease, etiology, comorbidities, and several other factors associated with outcomes.
Results: 140 pneumonia patients were evaluated and 41 patients met the severe pneumonia criteria. A
pathogen was found in 20 community-acquired pneumonia (CAP) and 13 hospital-acquired pneumonia
(HAP). The most frequently isolated pathogen from the sputum culture of patients with either severe CAP
or HAP was Acinetobacter baumannii. The mortality rate of severe HAP patients was higher than that
of severe CAP patients (84% vs. 65%), but the difference was nonsignificant. Most of the subjects had
comorbidities (CAP 75%, HAP 61.6%). Procalcitonin (PCT) and C-reactive protein (CRP) levels in severe
CAP were higher than those in severe HAP (PCT 7.7 vs 6.0, p=0.658; CRP 163.1 vs 93.6, p=0.580), but the
differences were also nonsignificant.
Conclusion: The most frequently isolated pathogens from the sputum culture of patients with severe
pneumonia were Acinetobacter baumanii, which should be considered at the time of diagnosis and empirical
antibiotic therapy. Severe pneumonia was often accompanied by comorbidities, inflammation responses
increase in both severe CAP and HAP with a high mortality rate.