Mortality from invasive pneumococcal pneumonia in the era of antibiotic resistance, 1995-1997

Abstract

OBJECTIVES: This study examined epidemiologic factors affecting mortality from pneumococcal pneumonia in 1995 through 1997. METHODS: Persons residing in a surveillance area who had community-acquired pneumonia requiring hospitalization and Streptococcus pneumoniae isolated from a sterile site were included in the analysis. Factors affecting mortality were evaluated in univariate and multivariate analyses. The number of deaths from pneumococcal pneumonia requiring hospitalization in the United States in 1996 was estimated. RESULTS: Of 5837 cases, 12% were fatal. Increased mortality was associated with older age, underlying disease. Asian race, and residence in Toronto/Peel, Ontario. When these factors were controlled for, increased mortality was not associated with resistance to penicillin or cefotaxime. However, when deaths during the first 4 hospital days were excluded, mortality was significantly associated with penicillin minimum inhibitory concentrations of 4.0 or higher and cefotaxime minimum inhibitory concentrations of 2.0 or higher. In 1996, about 7000 to 12,500 deaths occurred in the United States from pneumococcal pneumonia requiring hospitalization. CONCLUSIONS: Older age and underlying disease remain the most important factors influencing death from pneumococcal pneumonia. Mortality was not elevated in most infections with beta-lactam-resistant pneumococci.

Biological and Epidemiological Features of Antibiotic-Resistant Streptococcus pneumoniae in Pre- and Post-Conjugate Vaccine Eras: a United States Perspective

“…In contrast to previous studies that found no difference in mortality, both Metlay et al and Feiken et al demonstrated that there was an increased risk of mortality among persons infected with nonsusceptible and resistant S. pneumoniae (34,35). Metlay et al found that in-hospital mortality was significantly increased among cases with PNSP bacteremic pneumonia compared to those with penicillin-susceptible S. pneumoniae (relative risk, 2.1; 95% confidence interval, 1.0 to 4.3) (34), while in the study by Feiken et al, mortality was significantly increased in U.S. persons infected with pneumococci with penicillin MICs of Ն4.0 g/ml after the fourth day of hospitalization (35).…”

“…This finding was also documented by Plouffe et al among pneumococcal bacteremia cases in 10 adult care hospitals in Franklin County, OH, but those authors found that the duration of hospitalization was significantly longer for patients with penicillin-nonsusceptible S. pneumoniae (PNSP) than for those with penicillin-susceptible disease (15.8 days versus 12.1 days; P ϭ 0.05) (33). In contrast to previous studies that found no difference in mortality, both Metlay et al and Feiken et al demonstrated that there was an increased risk of mortality among persons infected with nonsusceptible and resistant S. pneumoniae (34,35). Metlay et al found that in-hospital mortality was significantly increased among cases with PNSP bacteremic pneumonia compared to those with penicillin-susceptible S. pneumoniae (relative risk, 2.1; 95% confidence interval, 1.0 to 4.3) (34), while in the study by Feiken et al, mortality was significantly increased in U.S. persons infected with pneumococci with penicillin MICs of Ն4.0 g/ml after the fourth day of hospitalization (35).…”

“…Only higher penicillin MICs (Ն4 g/ml) have been associated with treatment failures of nonmeningitis IPD cases (35). This level of resistance was associated with ϳ8% of IPD cases in the United States immediately prior to PCV7 introduction (data not shown).…”

Absence of leukocytosis in bacteraemic pneumococcal pneumonia

“…1 An estimated 5.6 million cases of CAP occur annually in the United States, 2 with 1.2 million patients hospitalised and an inpatient mortality rate of 5.8%. 3 Streptococcus pneumoniae accounts for about 50% of all cases of CAP requiring admission to hospital.…”

Serotype Distribution and Antimicrobial Resistance of Adult <i>Streptococcus pneumoniae</i> Clinical Isolates over the Period 2001–2008 in Crete, Greece

“…Streptococcus pneumoniae is the most important bacterial pathogen implicated in community-acquired invasive and non-invasive infections and is associated with significant morbidity, mortality and financial expenditures [1,2,3]. Timely and appropriate empirical antimicrobial treatment is critical to improve outcome and reduce mortality rates [4,5].…”