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Pneumococcal pneumonia: differences according to blood culture results.

Capelastegui A, Zalacain R, Bilbao A, Egurrola M, Iturriaga LA, Quintana JM, Gomez A, Esteban C, España PP - BMC Pulm Med (2014)

Bottom Line: Adjusted analysis showed a greater likelihood of septic shock during in-hospital course among patients with pneumococcal bacteremia (OR, 2.1; 95% CI, 1.2-3.5; P=0.006).Although host related factors and severity on admission were very similar in the two groups, bacteremic patients had worse in-hospital course and outcomes.Bacteraemia in pneumococcal pneumonia is of prognostic significance.

View Article: PubMed Central - HTML - PubMed

Affiliation: Service of Pneumology, Hospital de Galdakao-Usansolo, Galdakao, Bizkaia E-48960, Spain. alberto.capelasteguisaiz@osakidetza.net.

ABSTRACT

Background: Bacteremia by Streptococcus pneumoniae has been traditionally associated with poor outcomes in patients with pneumonia; however, data on its impact on outcomes are limited and are sometimes contradictory.

Methods: We performed a prospective study in two hospitals in northern Spain in which cases diagnosed with pneumococcal pneumonia were selected from a cohort of hospitalized patients with pneumonia between January 2001 and July 2009. We compared patients with pneumococcal bacteremic pneumonia with those with pneumococcal non-bacteremic pneumonia.

Results: We compared 492 patients with negative blood culture and 399 with positive culture results. Host related factors were very similar in both groups. Severity of illness on admission measured by CURB-65 score was similar in both groups. Adjusted analysis showed a greater likelihood of septic shock during in-hospital course among patients with pneumococcal bacteremia (OR, 2.1; 95% CI, 1.2-3.5; P=0.006). Likewise, patients with positive blood culture had greater in-hospital mortality (OR 2.1; 95% CI, 1.1- -3.9; P=0.02), 15-day mortality (OR 3.6; 95% CI, 1.7-7.4; P=0.0006), and 30-day mortality (OR, 2.7; 95% CI, 1.5-5; P=0.002).

Conclusions: Although host related factors and severity on admission were very similar in the two groups, bacteremic patients had worse in-hospital course and outcomes. Bacteraemia in pneumococcal pneumonia is of prognostic significance.

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Related in: MedlinePlus

Kaplan-Meier survival curves for the blood culture positive and negative patients.
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Figure 1: Kaplan-Meier survival curves for the blood culture positive and negative patients.

Mentions: Table 4 shows the comparison of in-hospital course and outcomes in the two groups adjusting for severity of illness at admission, measured by CURB-65, as well as for patient characteristics and variables related to the process of care found to be significantly different in the two groups of patients, such as sex, congestive heart failure, alcoholism, pneumococcal vaccine in last 5 years, pleural effusion, appropriate antibiotic, antibiotics within 4 hours, dual antibiotic therapy including a macrolide, and antibiotic administration prior to hospital admission. A higher likelihood of septic shock (OR, 2.1; 95% CI, 1.2 – 3.5; P = 0.006) during the hospital stay was found among patients with pneumococcal bacteremia. Likewise, patients with positive blood cultures had higher in-hospital mortality (OR 2.1; 95% CI, 1.1 - 3.9; P = 0.02), 15-day mortality (OR, 3.6; 95%CI, 1.7 - 7.4; P = 0.0006), and 30-day mortality (OR, 2.7; 95% CI, 1.5 - 5; P = 0.002). Kaplan-Meier survival curves for each of the groups demonstrate markedly different survival trajectories in 15- and 30-day mortality (Figure 1). Adjusted cox proportional hazards models confirmed the previous comparison of survival between the two groups of patients: for 15-day mortality, the HR was 3.3 (95% CI, 1.7 - 6.5, P = 0.0005); and for 30-day mortality, the HR was 2.8 (95% CI, 1.6 - 5.1, P = 0.0006).


Pneumococcal pneumonia: differences according to blood culture results.

Capelastegui A, Zalacain R, Bilbao A, Egurrola M, Iturriaga LA, Quintana JM, Gomez A, Esteban C, España PP - BMC Pulm Med (2014)

Kaplan-Meier survival curves for the blood culture positive and negative patients.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4127038&req=5

Figure 1: Kaplan-Meier survival curves for the blood culture positive and negative patients.
Mentions: Table 4 shows the comparison of in-hospital course and outcomes in the two groups adjusting for severity of illness at admission, measured by CURB-65, as well as for patient characteristics and variables related to the process of care found to be significantly different in the two groups of patients, such as sex, congestive heart failure, alcoholism, pneumococcal vaccine in last 5 years, pleural effusion, appropriate antibiotic, antibiotics within 4 hours, dual antibiotic therapy including a macrolide, and antibiotic administration prior to hospital admission. A higher likelihood of septic shock (OR, 2.1; 95% CI, 1.2 – 3.5; P = 0.006) during the hospital stay was found among patients with pneumococcal bacteremia. Likewise, patients with positive blood cultures had higher in-hospital mortality (OR 2.1; 95% CI, 1.1 - 3.9; P = 0.02), 15-day mortality (OR, 3.6; 95%CI, 1.7 - 7.4; P = 0.0006), and 30-day mortality (OR, 2.7; 95% CI, 1.5 - 5; P = 0.002). Kaplan-Meier survival curves for each of the groups demonstrate markedly different survival trajectories in 15- and 30-day mortality (Figure 1). Adjusted cox proportional hazards models confirmed the previous comparison of survival between the two groups of patients: for 15-day mortality, the HR was 3.3 (95% CI, 1.7 - 6.5, P = 0.0005); and for 30-day mortality, the HR was 2.8 (95% CI, 1.6 - 5.1, P = 0.0006).

Bottom Line: Adjusted analysis showed a greater likelihood of septic shock during in-hospital course among patients with pneumococcal bacteremia (OR, 2.1; 95% CI, 1.2-3.5; P=0.006).Although host related factors and severity on admission were very similar in the two groups, bacteremic patients had worse in-hospital course and outcomes.Bacteraemia in pneumococcal pneumonia is of prognostic significance.

View Article: PubMed Central - HTML - PubMed

Affiliation: Service of Pneumology, Hospital de Galdakao-Usansolo, Galdakao, Bizkaia E-48960, Spain. alberto.capelasteguisaiz@osakidetza.net.

ABSTRACT

Background: Bacteremia by Streptococcus pneumoniae has been traditionally associated with poor outcomes in patients with pneumonia; however, data on its impact on outcomes are limited and are sometimes contradictory.

Methods: We performed a prospective study in two hospitals in northern Spain in which cases diagnosed with pneumococcal pneumonia were selected from a cohort of hospitalized patients with pneumonia between January 2001 and July 2009. We compared patients with pneumococcal bacteremic pneumonia with those with pneumococcal non-bacteremic pneumonia.

Results: We compared 492 patients with negative blood culture and 399 with positive culture results. Host related factors were very similar in both groups. Severity of illness on admission measured by CURB-65 score was similar in both groups. Adjusted analysis showed a greater likelihood of septic shock during in-hospital course among patients with pneumococcal bacteremia (OR, 2.1; 95% CI, 1.2-3.5; P=0.006). Likewise, patients with positive blood culture had greater in-hospital mortality (OR 2.1; 95% CI, 1.1- -3.9; P=0.02), 15-day mortality (OR 3.6; 95% CI, 1.7-7.4; P=0.0006), and 30-day mortality (OR, 2.7; 95% CI, 1.5-5; P=0.002).

Conclusions: Although host related factors and severity on admission were very similar in the two groups, bacteremic patients had worse in-hospital course and outcomes. Bacteraemia in pneumococcal pneumonia is of prognostic significance.

Show MeSH
Related in: MedlinePlus