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

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


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.

Publication types

  • Review

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Anti-Inflammatory Agents, Non-Steroidal*
  • Community-Acquired Infections / complications
  • Community-Acquired Infections / drug therapy
  • Community-Acquired Infections / mortality
  • Comorbidity
  • Contraindications
  • Female
  • Hospitalization
  • Humans
  • Inappropriate Prescribing / adverse effects
  • Intensive Care Units
  • Male
  • Middle Aged
  • Noninvasive Ventilation
  • Pleural Effusion / diagnosis
  • Pneumonia, Pneumococcal / complications
  • Pneumonia, Pneumococcal / drug therapy*
  • Pneumonia, Pneumococcal / mortality
  • Prospective Studies
  • Retrospective Studies
  • Risk
  • Streptococcus pneumoniae / isolation & purification


  • Anti-Inflammatory Agents, Non-Steroidal