This work was supported by PII (Programme of research of SEPAR) in respiratory infection; CIBERES (Centro de investigación en red de enfermedades respiratorias) an initiative of ISCIII (Instituto de Salud Carlos III); Beca Fis (PI04/1150); Beca SEPAR (Sociedad Española de Neumología y Cirugía torácica) (2006/0237) and Beca de la Consellería Sanitat Comunidad Valenciana (2007/ 0059).

Altres ajuts: SEPAR/2006/0237

Background: Severe sepsis, may be present on hospital arrival in approximately one-third of patients with community-acquired pneumonia (CAP). Objective: To determine the host characteristics and micro-organisms associated with severe sepsis in patients hospitalized with CAP. Results: We performed a prospective multicenter cohort study in 13 Spanish hospital, on 4070 hospitalized CAP patients, 1529 of whom (37.6%) presented with severe sepsis. Severe sepsis CAP was independently associated with older age (>65 years), alcohol abuse (OR, 1.31; 95% CI, 1.07-1.61), chronic obstructive pulmonary disease (COPD) (OR, 1.75; 95% CI, 1.50-2.04) and renal disease (OR, 1.57; 95% CI, 1.21-2.03), whereas prior antibiotic treatment was a protective factor (OR, 0.62; 95% CI, 0.52-0.73). Bacteremia (OR, 1.37; 95% CI, 1.05-1.79), S pneumoniae (OR, 1.59; 95% CI, 1.31-1.95) and mixed microbial etiology (OR, 1.65; 95% CI, 1.10-2.49) were associated with severe sepsis CAP. Conclusions: CAP patients with COPD, renal disease and alcohol abuse, as well as those with CAP due to S pneumonia or mixed micro-organisms are more likely to present to the hospital with severe sepsis.