Bacteraemic pneumococcal pneumonia and SARS-CoV-2 pneumonia: differences and similarities

Abstract

Objective: To analyse differences in clinical presentation and outcome between bacteraemic pneumococcal community-acquired pneumonia (B-PCAP) and sSvere Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) pneumonia. Methods: This observational multi-centre study was conducted on patients hospitalized with B-PCAP between 20 0 0 and 2020 and SARS-CoV-2 pneumonia in 2020. Thirty-day survival, predictors of mortality, and intensive care unit (ICU) admission were compared. Results: In total, 663 patients with B-PCAP and 1561 patients with SARS-CoV-2 pneumonia were included in this study. Patients with B-PCAP had more severe disease, a higher ICU admission rate and more complications. Patients with SARS-CoV-2 pneumonia had higher in-hospital mortality (10.8% vs 6.8%; P = 0.004). Among patients admitted to the ICU, the need for invasive mechanical ventilation (69.7% vs 36.2%; P < 0.001) and mortality were higher in patients with SARS-CoV-2 pneumonia. In patients with B-PCAP, the predictive model found associations between mortality and systemic complications (hyponatraemia, septic shock and neurological complications), lower respiratory reserve and tachypnoea; chest pain and purulent sputum were protective factors in these patients.

Validation of the qSOFA and CRB-65 in SARS-CoV-2-infected community-acquired pneumonia

“…Patients with CAP and SARS-CoV-2 infection had a significantly higher risk of dying (22.7% vs. 15.7%) or mechanical ventilation (14.9% vs. 9.2%) compared to CAP without SARS-CoV-2 infection. Such differences also have been described by others [16,17], however for direct comparison of CAP patients with and without SARS-CoV-2 infection hospitalized within the same period we found surprisingly few data. Mortality rate in our cohort of hospitalized CAP and COVID-19 was high compared to previous prospective studies [8,16,18], but closely resembled that of other European population-based cohorts for hospitalized CAP [19][20][21] and COVID-19 [9,10,12,22].…”

“…Such differences also have been described by others [16,17], however for direct comparison of CAP patients with and without SARS-CoV-2 infection hospitalized within the same period we found surprisingly few data. Mortality rate in our cohort of hospitalized CAP and COVID-19 was high compared to previous prospective studies [8,16,18], but closely resembled that of other European population-based cohorts for hospitalized CAP [19][20][21] and COVID-19 [9,10,12,22]. Additionally, the median age of our cohorts was high with 72 years in SARS-CoV-2 positive and 78 years in SARS-CoV-2 negative patients, respectively.…”

“…Of note, older age defined by the CRB-65 cut-off of 65 years was associated with a much higher relative mortality risk in SARS-CoV-2 positive CAP compared to SARS-CoV-2 negative CAP in multivariable analyses, underscoring the dominating prognostic relevance of age described in COVID-19 [22,23]. On the other hand, pneumonia-related confusion showed a stronger association with mechanical ventilation and mortality in SARS-CoV-2 negative (RR 2.2 and 1.9) compared to SARS-CoV-2 positive (RR 1.5 and 1.6) patients, probably reflecting the lower rate of extra-pulmonary sepsis in patients with COVID-19 compared to bacterial CAP [16].…”