Streptococcus pneumoniae is a common pathogen involved in community-acquired pneumonia. Invasive pneumococcal disease is often associated with higher co-morbidity rates, but mortality-related findings have been inconclusive. This study investigated predictors of 30-day mortality and invasive pneumococcal disease. Methods: This retrospective analysis included adults with pneumococcal disease who were admitted to Pamela Youde Nethersole Eastern Hospital from 1 January 2011 to 31 December 2018. Demographics, microbiological characteristics, and outcomes were compared between 30-day survivors and non-survivors, and between patients with invasive disease and those with non-invasive disease. Intensive care unit (ICU) subgroup analysis was performed. The primary outcome was 30-day all-cause mortality; secondary outcomes were ICU and hospital mortalities, and ICU and hospital lengths of stay. Results: In total, 792 patients had pneumococcal disease; 701 survived and 91 (11.5%) died within 30 days. Notably, 106 (13.4%) patients had invasive pneumococcal disease and 170 (21.5%) patients received intensive care. Vasopressor use (odds ratio [OR]=4.96, P<0.001), chronic kidney disease (OR=3.62, P<0.001), positive urinary antigen test results (OR=2.57, P=0.001), and advanced age

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A 69-year-old man with a history of diabetes mellitus and benign prostatic hypertrophy was admitted to our medical unit with a 1-week history of fever, runny nose, and shortness of breath. Chest X-ray revealed bilateral diffuse ground glass opacities in both lung fields. The patient had type 1 respiratory failure and required non-invasive positive pressure ventilation to maintain oxygenation. The patient was given ceftriaxone 1 g every 12 hours, and doxycycline 100 mg and oseltamivir 75 mg twice daily. He was transferred to the intensive care unit and intubated due to severe acute respiratory distress syndrome (ARDS). The patient's nasopharyngeal swab was tested by polymerase chain reaction and the result was positive for influenza A virus H1 RNA. His clinical course was further complicated by septic acute kidney injury that necessitated continuous venovenous haemofiltration. His lungs gradually improved with supportive measures including prone ventilation and muscle paralysis for 48 hours. The fractional oxygenation requirement improved from 1.0 to 0.4 between day 1 and day 8 of admission and chest X-ray showed improving aeration of both lungs.