Contribution of host, bacterial factors and antibiotic treatment to mortality in adult patients with bacteraemic pneumococcal pneumonia

Nauclér, Pontus; Darenberg, Jessica; Morfeldt, Eva; Örtqvist, Åke; Normark, Birgitta Henriques

doi:10.1136/thoraxjnl-2012-203106

Cited by 105 publications

(77 citation statements)

References 34 publications

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“…While the aforementioned pneumococcal serotypes remained associated with respiratory failure, age and chronic respiratory and cardiac disease remained as predictors of respiratory failure. In another recent study of death in invasive pneumococcal disease, associations with specific pneumococcal serotypes were mitigated by host factors including age, alcoholism, liver or renal disease and the presence of solid tumours [15]. While methodological weaknesses in application of retrospective control for such factors may have led to spurious association with pneumococcal serotype, animal studies confirm that these are important in defining the clinical phenotype.…”

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confidence: 75%

Pneumococcal serotypes and respiratory failure: soil or seed?

Woodhead¹

2014

Eur Respir J

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@ERSpublications Small differences in the capsule of causative bacteria may determine the exact pattern of clinical illness in pneumonia http://ow.ly/qlQbA When considering the microbial aetiology of community-acquired pneumonia (CAP) we seldom think beyond the name (genus and species) of the causative organism. In a recent study of CAP aetiology in outpatients, Streptococcus pneumoniae was reported to be the most frequent pathogen [1]; unchanged from previous studies. The knowledge that S. pneumoniae is the commonest cause is sufficient to assist the choice of appropriate antibiotics; the most important management decision required for most patients.However, there is a lot more to this bacterial species than the name might imply. In fact, there are now known to be .90 distinct pneumococcal serotypes, each characterised by a slightly different structure in the pneumococcal capsular polysaccharide. These small molecular differences are an important determinant of immune response; therefore, immunity is serotype specific. Studies in the pre-antibiotic era dealt in depth with serotype distributions, as at that time serotype specific serum was the only available therapy. With the advent of antibiotics, pneumococcal serotypes have received much less attention. Now with the development of pneumococcal vaccines, and the importance of matching vaccines to causative serotypes, this subject is having a renaissance. From this we are starting to understand that there is more to the different serotypes than just a difference in polysaccharide structure. Indeed, the serotype is increasingly being linked, not just with the immune response, but also with the clinical phenotype in individual patients.In this issue of the European Respiratory Journal, BURGOS et al.[2] describe an investigation into the risk factors for respiratory failure (defined as an oxygen saturation of ,90% on room air or an arterial oxygen tension/inspiratory oxygen fraction ratio ,250) in a prospectively collected cohort of 1258 adults admitted to hospital with invasive (i.e. blood culture positive) pneumococcal pneumonia. Patients with respiratory failure (present in 48.9% of cases) were perhaps not surprisingly older, were more likely to have had chronic heart or lung disease, were more severely ill (as judged by the presence of septic shock and pneumonia severity index score), had more extensive radiographic change, were more likely to have received assisted ventilation and intensive care unit admission, and were more likely to have died. After multivariate analysis, age, chronic heart or lung disease, and pneumococcal serotypes 3, 19A and 19F remained associated with respiratory failure, while type 1 remained associated with its absence. This is the first study to find an association between specific serotypes and the presence or absence of respiratory failure. Previous studies have found associations between patterns of serotypes and other clinical phenotypes including nasopharyngeal carriage [3], invasive disease [4], septic shock [5], empyema and pa...

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confidence: 75%

Pneumococcal serotypes and respiratory failure: soil or seed?

Woodhead¹

2014

Eur Respir J

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“…In a study by Millet et al investigating factors associated with hospitalization within 28 days of CAP diagnosis (a'post-CAP' hospitalization), smokers had nearly three times the odds of hospitalization than non-smoker, and after adjustments for comorbidities, 96% higher odds of hospitalization than non-smokers [78]. Smoking is an independent risk factor for mortality associated with CAP; in a study of patients hospitalized with CAP, current smokers had a fivefold increased risk of 30-day mortality from pneumococcal CAP compared to non-smokers and ex-smokers [72].…”

Section: Discussionmentioning

confidence: 99%

“…Initial empiric management of CAP in regions where comorbidity prevalence is highest is critically important as these patients are already at higher risk for CAP [71], as well as the severity and outcome of the episode [65]. Research has shown that patients with chronic disease comorbidities, such as diabetes or who smoke, are more likely to receive inappropriate therapy, have longer hospital stays, are more likely to be re-admitted in 30 days [25], and are at increased risk of death due to CAP over both short (30 days) and long term (1 year) time frames [72]. Recommendations suggest such patients should be given initial therapy of fluoroquinolones or a combination of beta-lactam+macrolide agents [5].…”

Section: Discussionmentioning

confidence: 99%

Application of the Formula for Rational Antimicrobial Therapy (FRAT) to Community-Acquired Pneumonia

Blondeau¹,

Theriault²

2017

J Infect Dis Ther

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Community-acquired pneumonia (CAP) remains a common condition for which patients seek medical advice in the outpatient setting and where antimicrobial agents are prescribed empirically-often based on therapeutic guideline recommendations. Antimicrobial resistance impacts on therapeutic choices as resistance is associated with clinical failure which in turn may impact morbidity and mortality. The Formal for Rational Antimicrobial Therapy (FRAT) considers etiology and antimicrobial susceptibility to generate a factor to predict the likely activity of an antimicrobial agent in CAP or any other infection for which etiology and susceptibility data can be considered. In considering the FRAT formula in CAP, amoxicillin and macrolides offer a predictability of 52.6-78.3% whereas for trimethoprim/sulfamethoxazole the predictability was 45.2% as compared to 90.1% for tetracyclines/doxycycline and 98.2% for levofloxacin (and moxifloxacin). The FRAT formula clearly differentiates antimicrobial agents based on spectrum of activity and impact of antimicrobial resistance and provides yet another factor for consideration in the selection of an antimicrobial agent for treatment of CAP.

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“…8 With regard to bacteraemic pneumococcal pneumonia, one study which 6 investigated host, bacterial and treatment factors impacting on outcome suggested that a number of host factors were more important than specific pneumococcal serotypes in determining mortality, which has implications not only for prognostication, but also for targeting certain individuals for preventive strategies. 23 In addition, it has been documented that early administration of appropriate antibiotic therapy is a critical determinant of survival in patients with bacteraemic pneumococcal CAP.…”

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confidence: 99%