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

Abstract

Bacteremic pneumococcal CAP patients were significantly associated with higher in-hospital mortality, lower TCS, and longer LOS. HIV-infected patients showed a greater mortality which was not statistically significant. Bacteremic pneumococcal CAP patients had higher levels of biomarkers and systemic cytokines.

Predicting bacteraemia or rapid identification of the causative pathogen in community acquired pneumonia: where should the priority lie?

“…However, this will have little clinical utility unless these parameters also differentiated pneumococcal septicaemia from all patients with CAP (not just pneumococcal CAP) or a point of care test for S. pneumoniae, such as urinary antigen detection, was used routinely. Previous studies are consistent with the present study, with pleural effusions and multi-lobar infiltrates being associated with an increased proportion of positive blood cultures, and increased age and the presence of chronic obstructive pulmonary disease being associated with negative blood cultures [12][13][14]. These studies also identified additional factors associated with positive blood cultures including male sex, congestive heart failure, alcohol and drug abuse, hypoalbuminaemia, hyponatraemia, tachycardia and hypotension [13,14], which were not corroborated by AMARO et al [7].…”

“…Previous studies are consistent with the present study, with pleural effusions and multi-lobar infiltrates being associated with an increased proportion of positive blood cultures, and increased age and the presence of chronic obstructive pulmonary disease being associated with negative blood cultures [12][13][14]. These studies also identified additional factors associated with positive blood cultures including male sex, congestive heart failure, alcohol and drug abuse, hypoalbuminaemia, hyponatraemia, tachycardia and hypotension [13,14], which were not corroborated by AMARO et al [7]. Overall, these data provide a strong degree of confidence that effusions and multi-lobe diseases are positively associated and chronic lung disease and older age are negatively associated with blood culture positive S. pneumoniae CAP.…”

“…However, previous studies found that positive blood cultures in pneumococcal pneumonia were associated with an increased risk of septic shock and mortality [12,15]. Furthermore, a secondary analysis of the Community-Acquired Pneumonia Organization (CAPO) database demonstrated an increased mortality amongst blood culture-positive pneumococcal pneumonia patients [14]. Technical differences may explain the discrepancy in the significance of a positive blood culture for S. pneumoniae on mortality.…”

“…False-negative blood culture results due to pre-admission antibiotics or insensitive culture techniques could also potentially explain the lack of association of positive blood cultures with poor outcome. Conversely, the CAPO database study may have been confounded by HIV since blood culture-positive patients without HIV did not have significant differences in the risk of mortality [14]. In the study by CAPELASTEGUI et al [12] a higher proportion of blood culture-negative patients received dual antibiotic therapy including a macrolide, which is associated with improved outcomes [16,17].…”

A cohort study of bacteremic pneumonia

“…[3–7] Nosocomial bacteremic pneumonia seems to have the greatest risk of mortality and excess length of stay, especially ventilator-associated pneumonia (VAP) and healthcare-associated pneumonia (HCAP). [4,5,8–12] One important factor contributing to high mortality is the antimicrobial resistance patterns exhibited by the microbes responsible for pneumonia. [13] Increasing antimicrobial resistance promotes greater administration of inappropriate initial antibiotic treatment (IIAT) (i.e., an antibiotic regimen without activity against the offending pathogen as demonstrated by in vitro susceptibility testing).…”