Invasive Disease vs Urinary Antigen-Confirmed Pneumococcal Community-Acquired Pneumonia

Ceccato, Adrián; Torres, Antoni; Amaro, Rosanel; Gabarrús, Albert; Polverino, Eva; Prina, Elena; García-Vidal, Carolina; Muñoz-Conejero, Eva; Méndez, Cristina; Cifuentes, Isabel; Casa, Jorge Puig de la Bella; Menéndez, Rosário; Niederman, Michael S.

doi:10.1016/j.chest.2017.01.005

Cited by 15 publications

(14 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Previous studies have shown low serum albumin or high serum CRP concentrations to be risk factors for bacteremia in patients with CAP [ 15 , 20 , 21 , 29 ]; our findings are consistent with this. Low serum albumin concentration is a risk factor for and a predictor of morbidity and mortality, regardless of the disease [ 30 ], and a relationship exists between hypoalbuminemia and severe infection due to the elevation of cytokine levels during systemic inflammation [ 31 ].…”

Section: Discussionsupporting

confidence: 93%

A model for predicting bacteremia in patients with community-acquired pneumococcal pneumonia: a retrospective observational study

et al. 2018

View full text Add to dashboard Cite

BackgroundPneumococcal pneumonia causes high morbidity and mortality among adults. This study aimed to identify risk factors for bacteremic pneumococcal pneumonia, and to construct a prediction model for the development of bacteremia in patients with community-acquired pneumococcal pneumonia.MethodsWe retrospectively analyzed data from patients hospitalized with community-acquired pneumococcal pneumonia between April 2007 and August 2015. Logistic regression models were applied to detect risk factors for pneumococcal bacteremia, and a receiver operating characteristic curve was used to devise a prediction model.ResultsBased on the results of sputum cultures, urine antigen tests, and/or blood cultures, 389 patients were diagnosed with pneumococcal pneumonia, 46 of whom had bacteremia. In the multivariate analysis, age < 65 years, serum albumin level < 3.0 g/dL, need for intensive respiratory or vasopressor support (IRVS), and C-reactive protein level > 20 mg/dL were identified as independent risk factors for the development of pneumococcal bacteremia. The bacteremia prediction score based on receiver operating characteristic curve analysis had a sensitivity of 0.74 and a specificity of 0.78 in patients with two risk factors. The area under the receiver operating characteristic curve was 0.77 (95% confidence interval (CI), 0.70–0.85).ConclusionsAge < 65 years, hypoalbuminemia, IRVS, and high C-reactive protein level on admission are independent risk factors for the development of bacteremia in patients with community-acquired pneumococcal pneumonia. A prediction model based on these four risk factors could help to identify patients with community-acquired pneumococcal pneumonia at high risk of developing bacteremia; this can be used to guide antibiotic choices.Trial registrationUMIN-CTR UMIN 000004353. Registered 7 October 2010. Retrospectively registered.

show abstract

Section: Discussionsupporting

confidence: 93%

A model for predicting bacteremia in patients with community-acquired pneumococcal pneumonia: a retrospective observational study

et al. 2018

View full text Add to dashboard Cite

show abstract

“…34 Moreover, the most common cause of bacteremic pneumonia was pneumococcus in 74% of patients, and although the authors did not look at CRP levels, patients with invasive pneumococcal CAP usually presented greater levels of CRP. 35 A recent meta-analysis that compared the combination of a b-lactam with a macrolide vs a b-lactam with a fluoroquinolone showed no significant differences in short-term mortality (adjusted risk ratio, 1.26; 95% CI, 0.95-1.67; I 2 , 43%) 36 ; and another metaanalysis showed that ceftriaxone combination therapy was similar in terms of treatment success compared with fluoroquinolone monotherapy in patients with CAP. 37 The study by Postma et al 6 was a cluster-randomized clinical trial that showed that a b-lactam was not inferior to a combination of a b-lactam with a macrolide or a fluoroquinolone alone for patients with nonsevere CAP; however, this study had several methodologic limitations that made the conclusions not generalized…”

Section: Discussionmentioning

confidence: 99%

Effect of Combined β-Lactam/Macrolide Therapy on Mortality According to the Microbial Etiology and Inflammatory Status of Patients With Community-Acquired Pneumonia

Ceccato¹,

Cillóniz²,

Martín‐Loeches

et al. 2019

Chest

Self Cite

View full text Add to dashboard Cite

BACKGROUND: Antibiotic combinations that include macrolides have shown lower mortality rates than b-lactams in monotherapy or combined with fluoroquinolones in patients with community-acquired pneumonia (CAP). However, this effect has not been studied according to the levels of C-reactive protein in CAP with identified microbial cause. In patients with CAP and known microbial cause we aimed to evaluate 30-day mortality of a b-lactam plus macrolide (BL þ M) compared with a fluoroquinolone alone or with a b-lactam (FQ AE BL). METHODS: We analyzed a prospective observational cohort of patients with CAP admitted to the Hospital Clinic of Barcelona between 1996 and 2016. We included only patients with known microbial cause. RESULTS: Of 1,715 patients (29%) with known etiology, a total of 932 patients (54%) received BL þ M. Despite lower crude mortality in the BL þ M group in the overall population (BL þ M, 5% vs FQ AE BL, 8%; P ¼ .015), after adjustment by a propensity score and baseline characteristics, the combination of BL þ M had a protective effect on mortality only in patients with high inflammatory response (C-reactive protein, > 15 mg/dL) and pneumococcal CAP (adjusted OR, 0.28; 95% CI, 0.09-0.93). No benefits on mortality were observed for the population without high inflammatory response and pneumococcal CAP or with other etiologies. CONCLUSIONS: The combination of a b-lactam with a macrolide was associated with decreased mortality in patients with pneumococcal CAP and in patients with high systemic inflammatory response. When both factors occurred together, BL þ M was protective for mortality in the multivariate analysis.

show abstract

“…Acute respiratory distress syndrome (ARDS) is a potential complication of severe CAP that is reported in ∼3% of patients hospitalised with pneumococcal CAP [9]. This condition is characterised by the rapid development of severe acute respiratory failure, and is associated with high morbidity and mortality despite advances in supportive care and ventilator management [10,11].…”

Section: Introductionmentioning

confidence: 99%

Acute respiratory distress syndrome in mechanically ventilated patients with community-acquired pneumonia

et al. 2018

Self Cite

View full text Add to dashboard Cite

Our aim was to assess the incidence, characteristics, aetiology, risk factors and mortality of acute respiratory distress syndrome (ARDS) in intensive care unit (ICU) patients with community-acquired pneumonia (CAP) using the Berlin definition.We prospectively enrolled consecutive mechanically ventilated adult ICU patients with CAP over 20 years, and compared them with mechanically ventilated patients without ARDS. The main outcome was 30-day mortality.Among 5334 patients hospitalised with CAP, 930 (17%) were admitted to the ICU and 432 required mechanical ventilation; 125 (29%) cases met the Berlin ARDS criteria. ARDS was present in 2% of hospitalised patients and 13% of ICU patients. Based on the baseline arterial oxygen tension/inspiratory oxygen fraction ratio, 60 (48%), 49 (40%) and 15 (12%) patients had mild, moderate and severe ARDS, respectively. was the most frequent pathogen, with no significant differences in aetiology between groups. Higher organ system dysfunction and previous antibiotic use were independent risk factors for ARDS in the multivariate analysis, while previous inhaled corticosteroids were independently associated with a lower risk. The 30-day mortality was similar between patients with and without ARDS (25% 30%, p=0.25), confirmed by propensity-adjusted multivariate analysis.ARDS occurs as a complication of CAP in 29% of mechanically ventilated patients, but is not related to the aetiology or mortality.

show abstract

Invasive Disease vs Urinary Antigen-Confirmed Pneumococcal Community-Acquired Pneumonia

Abstract: A high percentage of confirmed pneumococcal pneumonia is diagnosed by UAT. Despite differences in clinical characteristics and outcomes, IPP is not an independent risk factor for 30-day mortality compared with NIPP, reinforcing the importance of NIPP for pneumococcal pneumonia.

Cited by 15 publications

References 27 publications

A model for predicting bacteremia in patients with community-acquired pneumococcal pneumonia: a retrospective observational study

A model for predicting bacteremia in patients with community-acquired pneumococcal pneumonia: a retrospective observational study

Effect of Combined β-Lactam/Macrolide Therapy on Mortality According to the Microbial Etiology and Inflammatory Status of Patients With Community-Acquired Pneumonia

Acute respiratory distress syndrome in mechanically ventilated patients with community-acquired pneumonia

Contact Info

Product

Resources

About