Impacto de la bacteriemia en una cohorte de pacientes con neumonía neumocócica

Abstract

Objective: Bacteremia is the most common presentation of invasive disease in community-acquired pneumonia (CAP) due to Streptococcus pneumoniae. We investigated whether bacteremia in pneumococcal CAP worsens outcomes and whether it is related to pneumococcal vaccination (PV). Methods: Secondary analysis of a cohort of patients with pneumococcal CAP confirmed by blood culture, sputum culture, or urinary antigen testing. Demographic, clinical, radiographic, and biochemical data were collected, as were Acute Physiology and Chronic Health Evaluation II (APACHE II) and pneumonia severity index (PSI) scores, comorbidities, and PV history. We drew comparisons between patients with bacteremic pneumococcal CAP (BPP) and those with non-bacteremic pneumococcal CAP (NBPP). Results: Forty-seven patients had BPP, and 71 had NBPP (confirmed by sputum culture in 45 and by urinary antigen testing in 26); 107 had some indication for PV. None of the BPP patients had received PV, compared with 9 of the NBPP patients (p = 0.043). Among the BPP patients, the mean age was higher (76.4 ± 11.5 vs. 67.5 ± 20.9 years), as were APACHE II and PSI scores (16.4 ± 4.6 vs. 14.1 ± 6.5 and 129.5 ± 36 vs. 105.2 ± 45, respectively), as well as the rate of ICU admission for cardiopathy or chronic renal failure (42.5% vs. 22.5%), whereas hematocrit and plasma sodium levels were lower (35.7 ± 5.8 vs. 38.6 ± 6.7% and 133.9 ± 6.0 vs. 137.1 ± 5.5 mEq/L, respectively), although mortality was similar (29.8% vs 28.2%). Conclusions: In this population at high risk for CAP due to S. pneumoniae, the PV rate was extremely low (8.4%). Although BPP patients were more severely ill, mortality was similar between the two groups. Because PV reduces the incidence of BPP, the vaccination rate in at-risk populations should be increased.Keywords: Pneumococcal vaccines; Pneumonia, bacterial; Streptococcus pneumoniae; Pneumococcal infections; Mortality; Epidemiology. ResumenObjetivo: Bacteriemia es la forma invasiva más común de neumonía adquirida en la comunidad (NAC) por Streptococcus pneumoniae. Investigamos si la bacteriemia en NAC neumocócica empeora los resultados y si ella guarda relación con la vacunación antineumocócica (VAN). Métodos: Análisis secundario de una cohorte de pacientes con NAC neumocócica confirmada por cultivo de sangre o esputo o antígeno urinario. Se registraron datos demográficos, clínicos, radiográficos y de laboratorio, escores Higher Acute Physiology and Chronic Health Evaluation II (APACHE II) y pneumonia severity index (PSI), comorbilidades y antecedente de VAN. Se compararon pacientes con NAC neumocócica bacteriémica (NNB) vs. no bacteriémica (NNNB). Resultados: Cuarenta y siete pacientes tenían NNB y 71 NNNB (45 por cultivo de esputo y 26 por antígeno urinario); 107 tenían alguna indicación de VAN. Ningún paciente con NNB, pero 9 con NNNB, habían recibido VAN (p = 0,043). Los pacientes con NNB eran mayores (76,4 ± 11,5 vs. 67,5 ± 20,9 años), tenían mayor APACHE II (16,4 ± 4,6 vs. 14,1 ± 6,5) y PSI (129,5 ± 36 vs. 105,2 ± 45), más f...

Bacteremic pneumococcal pneumonia: serotype distribution, antimicrobial susceptibility, severity scores, risk factors, and mortality in a single center in Chile

“…The high prevalence of co-morbid conditions is a common feature in adult patients affected by pneumococcal pneumonia with or without bacteremia, underscoring the importance of host factors in disease progression, and at the same time, probably explaining why the bacteremic condition has not been clearly associated with a worst prognosis than cases without this condition. 4 , 5 , 17 , 18 The death toll observed in our work (33%) is in line with host characteristic (30%) and similar to figures reported in one group from Brazil. 5 However, it is higher than previous reports from Chile (10.9 and 20%).…”

“…3 , 4 It has sometimes been associated with a range of different serotypes, antibiotic resistance and a high case-fatality ratio. 3 , 5 , 6 , 7 Updated information about antibiotic resistance and serotype distribution is needed for antimicrobial treatment and to evaluate vaccine efficacy. However, data regarding serotype frequencies is scarce in adults in several countries of Latin America because it has mainly been focused on children.…”

Resistencia antibiótica y distribución de serotipos en cepas neumocócicas invasivas en adultos hospitalizados en Lima, Perú

“…Sin embargo, el estudio de Ileana Palma et al describen que en las neumonías no bacteriémicas la comorbilidad más frecuente es la EPOC, pero que en las neumonías bacteriémicas, las comorbilidades más importantes son la insuficiencia cardiaca y la renal, particularmente en ancianos; que suelen presentar disfunción neutrofílica, desnutrición y disminución de inmunoglobulinas (13) . Lo cual coincide con nuestros hallazgos, ya que la mayoría fueron neumonías bacteriémicas.…”

“…En este estudio se encontró que tener al menos una complicación y haber ingresado a una UCI, estuvo relacionado a mayor letalidad. Sin embargo, en la literatura se describen otros factores asociados como: presencia de más de una comorbilidad, edad mayor a 65 años, no estar vacunado, shock séptico e insuficiencia renal aguda, los cuales no pudieron ser evaluados por nuestro bajo número de casos (6,13,16,17) .…”

Impact of vaccination on the epidemiology and prognosis of pneumonia

“…Although different studies including a meta-analysis provided evidence that supports that PPSV23 would prevent invasive pneumococcal disease (IPD) in adults [9], non-invasive disease is not prevented by this vaccine, which is why the evidence is not clear regarding patients with chronic diseases. The vaccine is recommended in adults to prevent IPD [10].…”