Pneumopathies bactériennes atypiques en soins critiques

Atypical pneumonia accounts for 15 to 30% of the community-acquired pneumonias, and 7 to 14% of those admitted in ICU. Several bacteria may be involved, while Legionella pneumophila, Mycoplasma pneumoniae et Chlamydophila pneumoniae are the most frequently observed. Legionnaires’ disease is the most frequent one in ICU. It has also the poorest prognostic with ICU mortality up to 40% and is usually observed in comorbid or immunocompromised patients. On the other hand, most Chlamydophila pneumoniae and Mycoplasma pneumoniae pneumonias are documented in children or young adults without comorbidity, and their prognostic is usually better, but ICU mortality is still close to 25%. Macrolides and fluoroquinolones are currently the antibiotics of choice. Some specific features in the ICU care of these pneumonias must be known, also with low clinical evidence. Less common bacteria may be documented in the ICU such as Chlamydia psittacosis, Coxiella burnetii or Burkholderia pseudomallei, whose mortality may be up to 50%.