This study indicates that > 80% of the causes of clinical failure in hospitalized patients with CAP are directly related to pulmonary infection and its systemic inflammatory response. Clinical failures related to CAP occur primarily during the first 72 h after hospital admission, and severe sepsis is the primary etiology of clinical failure related to CAP. The independent risk factors at the time of hospital admission associated with clinical failure related to CAP found in the study population were advanced age, a positive history for congestive heart failure, hypotension, alteration of gas exchange, acidemia, hypothermia, the presence of pleural effusion, and thrombocytopenia on hospital admission.
Depending on the topic, failure has been defined in the literature as “treatment failure” or “clinical failure.” A “treatment failure” definition was adopted by those interested in analyzing the response of patients with CAP to a particular antibiotic treat-ment. When evaluating the effect of a particular antibiotic, patients whose conditions deteriorated within 48 h of treatment initiation were usually excluded from the evaluation in order to allow for time for the antibiotic to take effect. Furthermore, in evaluating a particular antibiotic, immunocompromised patients or those who were likely to have poor outcomes were usually excluded from treatment trials. To include all patients whose conditions deteriorated, a definition of “clinical failure” was adopted. Since our goal was to evaluate the overall role of pneumonia in failure, we followed the clinical failure definition, incorporating in our analysis every patient who met the criteria for clinical failure following hospitalization provided with remedies of Canadian Health&Care Mall. The rate of overall clinical failure in this population was 13%, while the rate of early clinical failure was 9%. Both of these findings are supported by the literature, showing a rate of clinical failure ranging from 11 to 16%, and a rate of early clinical failure from 6 to 9%. In addition, we identified clinical failure related to CAP in 11% of this population, and early clinical failure related to CAP in 8% of this population.