Comparison of prognostic factors between bacteraemic and non-bacteraemic critically ill immunocompetent patients in community-acquired severe pneumococcal pneumonia: a STREPTOGENE sub-study

Abstract

Background The presence of bacteraemia in pneumococcal pneumonia in critically ill patients does not appear to be a strong independent prognostic factor in the existing literature. However, there may be a specific pattern of factors associated with mortality for ICU patients with bacteraemic pneumococcal community-acquired pneumonia (CAP). We aimed to compare the factors associated with mortality, according to the presence of bacteraemia or not on admission, for patients hospitalised in intensive care for severe pneumococcal CAP. Methods This was a post hoc analysis of data from the prospective, observational, multicentre STREPTOGENE study in immunocompetent Caucasian adults admitted to intensive care in France between 2008 and 2012 for pneumococcal CAP. Patients were divided into two groups based on initial blood culture (positive vs. negative) for Streptococcus pneumoniae. The primary outcome was hospital mortality, which was compared between the two groups using odds ratios according to predefined variables to search for a prognostic interaction present in bacterial patients but not non-bacteraemic patients. Potential differences in the distribution of serotypes between the two groups were assessed. The prognostic consequences of the presence or not of initial bi-antibiotic therapy were assessed, specifically in bacteraemic patients. Results Among 614 included patients, 274 had a blood culture positive for S. pneumoniae at admission and 340 did not. The baseline difference between the groups was more frequent leukopaenia (26% vs. 14%, p = 0.0002) and less frequent pre-hospital antibiotic therapy (10% vs. 16.3%, p = 0.024) for the bacteraemic patients. Hospital mortality was not significantly different between the two groups (p = 0.11). We did not observe any prognostic factors specific to the bacteraemic patient population, as the statistical comparison of the odds ratios, as an indication of the association between the predefined prognostic parameters and mortality, showed them to be similar for the two groups. Bacteraemic patients more often had invasive serotypes but less often serotypes associated with high case fatality rates (p = 0.003). The antibiotic regimens were similar for the two groups. There was no difference in mortality for patients in either group given a beta-lactam alone vs. a beta-lactam combined with a macrolide or fluoroquinolone. Conclusion Bacteraemia had no influence on the mortality of immunocompetent Caucasian adults admitted to intensive care for severe pneumococcal CAP, regardless of the profile of the associated prognostic factors.

Diagnostic and prognostic implications of bacteremia in patients with complicated pleural infection

“…This study found that a higher RAPID score was significantly linked to overall mortality in patients with complicated pleural infections, consistent with previous research [ 9 , 24 , 28 ]. On the other hand, the presence of bacteremia did not seem to have a substantial impact on mortality in these patients, consistent with other recent studies suggesting that bacteremia was not associated with an increased risk of mortality in patients with pneumococcal pneumonia, including those admitted to intensive care unit [ 27 , 29 ]. The relatively lower diagnostic and prognostic value of blood culture testing implies limited usefulness in patients with pleural infection.…”

Comparison of clinical characteristics and outcomes of patients with sepsis identified by the Sepsis‐3 criteria by blood and urine culture results: A multicentre retrospective cohort study

“…10,11 Approximately 40% of patients admitted to ICU for pneumococcal community-acquired pneumonia are bacteremic, 26,27 and one recent study of ICU patients showed that the blood culture status had no influence on mortality outcomes. 28 The rate of bacteremia-positive sepsis in our ED cohort is 8%, approximately half of the 17% found in a study set in an ICU and three general wards combined, 5 and substantially lower than the 51% found in another ICU-only study. 6 As patients transferred to ICU have already had a deteriorating condition identified, this highlights the important role of the ED in triage and investigation of the diverse patient groups presenting with suspected sepsis.…”

“…Severe respiratory infections are more commonly culture‐negative, with studies finding an association between CNSS and higher rates of respiratory infection 10,11 . Approximately 40% of patients admitted to ICU for pneumococcal community‑acquired pneumonia are bacteremic, 26,27 and one recent study of ICU patients showed that the blood culture status had no influence on mortality outcomes 28 …”

“… 10 , 11 Approximately 40% of patients admitted to ICU for pneumococcal community‑acquired pneumonia are bacteremic, 26 , 27 and one recent study of ICU patients showed that the blood culture status had no influence on mortality outcomes. 28 …”

Meningitis in critically ill patients admitted to intensive care unit for severe community-acquired pneumococcal pneumonia

“…Although previous studies did not report the proportion of lumbar puncture and therefore meningitis in patients admitted to ICU for pneumococcal pneumonia [ 7 , 9 , 11 ], a mortality rate from neurological cause from 5 to 7% was reported [ 9 , 11 , 22 ], suggesting that some of these patients may have undiagnosed meningitis. In this regard, Figueiredo and colleagues found that in patients admitted for bacterial meningitis, mainly pneumococcal meningitis, pneumonia was a frequent coexisting infection on admission [ 23 ].…”