Outcomes of hospitalized patients with bacteraemic and non-bacteraemic community-acquired pneumonia caused by Streptococcus pneumoniae

Abstract

In contrast to bacteraemic pneumococcal community-acquired pneumonia (CAP), there is a paucity of data on the clinical characteristics and outcomes of non-bacteraemic pneumococcal CAP. This retrospective study compared the outcome of hospitalized patients with bacteraemic and non-bacteraemic pneumococcal CAP treated at a medical centre from 2004 to 2008. Data on clinical outcomes including all-cause mortality, length of hospital stay, need for intensive-care unit admission and extrapulmonary involvement were analysed. In all, 221 patients with pneumococcal pneumonia (87 bacteraemic, 134 non-bacteraemic) were included. Patients with bacteraemic pneumococcal pneumonia (BPP) were older than those with non-BPP (46·2 ± 30·7 years vs. 21·7 ± 30·8 years, P<0·001) and were more likely to have underlying medical diseases (66·7% vs. 33·6%, P<0·001). The overall mortality rates at 7, 14, and 30 days were significantly higher in BPP than non-BPP patients (12·6% vs. 2·2%, 14·9% vs. 3·7%, 19·5% vs. 5·1%, all P<0·01). Multivariate logistic regression analysis showed that pneumococcal bacteraemia was correlated with extrapulmonary involvement (odds ratio 5·46, 95% confidence interval 1·97-15·16, P=0·001). In conclusion, S. pneumoniae bacteraemia increased the risk of mortality and extrapulmonary involvement in patients with pneumococcal CAP.

Bacteremic pneumococcal pneumonia: clinical outcomes and preliminary results of inflammatory response

“…Kaplan-Meier curve for length of stay among 439 non-bacteremic and 394 bacteremic patients with S. pneumoniae community-acquired pneumonia The results of our study contradict prior reports suggesting no association of bacteremic pneumococcal CAP and poor outcomes [13,14]. However, other investigators have found that bacteremia is a risk factor for death in patients with pneumococcal CAP [6][7][8][9][10][11]. In a prospective study carried in two hospitals in northern Spain (2001-2009), Capelastegui et al compared 492 non-bacteremic pneumococcal CAP patients with 399 bacteremic pneumococcal CAP [10].…”

“…Despite these interventions, S. pneumoniae remains the most common cause of CAP, of which 20 % of cases are accompanied with bacteremia [5]. Controversy still exists regarding the impact of bacteremia on the clinical outcomes of hospitalized patients with pneumococcal CAP [6][7][8][9][10][11][12][13][14][15].…”

Adherence to SATS antibiotic recommendations in patients with community acquired pneumonia in Johannesburg, South Africa

“…The previous South African study documented an overall mortality of 20%, this being 28.5% in those given guideline-adherent therapy, and 19% in those given guideline-nonadherent therapy, which was not significantly different; p = 0.71) [7]. The reasons for the differences in mortality between these two studies is uncertain but may relate to the fact that the earlier study was restricted to the investigation only of severely ill cases with CAP, and also that microorganisms were isolated in a significantly greater number of the cases (although the site of isolation was not reported) and CAP cases that are more severe [9], as well as those that have documented bacteraemia are known to have a poorer prognosis [16]. An additional reason that non-adherent therapy was not associated with a higher mortality in either of the studies may relate to the fact that in both studies, those patients that received non-adherent therapy, had not received, in most cases, inadequate therapy, but had received antibiotic therapy in excess of what was recommended [7].…”

Diabetes and Infection: Is There a Link? - A Mini-Review

“…There is evidence suggesting that infections by some organisms, such as Streptococcus pneumoniae, are linked to higher rates of bacteremia [10], which was proposed to explain higher mortality rates from pneumococcal pneumonia in these patients [9]. However, this conclusion is not unequivocally accepted, as other reports did not find higher rates of bacteremia in diabetic patients with pneumococcal pneumonia [11]. In addition, a recent report from the Community-Acquired Pneumonia Organization international cohort study not only disclosed that pneumococcal bacteremia did not impact the outcome, they moreover reported that people with diabetes mellitus were more likely to achieve clinical stability and that diabetes was not a risk factor for death when suffering from bacteremic pneumococcal infection [12].…”