Determinants of outcome in patients with bacteraemic pneumococcal pneumonia: Importance of early adequate treatment

Abstract

We set out to determine the factors influencing mortality in 125 adult patients with bacteraemic pneumococcal community-acquired pneumonia (CAP), assessing the impact on outcomes of early adequate therapy in particular. Presumed prognostic factors with p < 0.1 in the unadjusted model were subjected to multivariate Cox regression analysis, with in-hospital and 90-day mortalities as the dependent variables. A time period of >4 h from admission to start of adequate antibiotic treatment (adjusted hazard ratio (aHR) 2.62, 95% confidence interval (CI) 1.06-6.45; p =0.037) and severe sepsis or septic shock (aHR 5.06, 95% CI 1.63-15.71; p = 0.005) were independently associated with in-hospital mortality. Variables associated with 90-day mortality were Charlson comorbidity index (aHR 1.17, 95% CI 1.02-1.34; p = 0.018), severe sepsis or septic shock (aHR 3.03, 95% CI 1.22-7.51; p = 0.016) and delay of adequate antibiotic therapy >4 h (aHR 2.21, 95% CI 1.01-4.86; p = 0.048). The use of combination therapy was not included in these models but was a protective factor for delayed adequate therapy (aHR 0.53, 95% CI 0.29-0.95; p = 0.033). Administration of adequate antimicrobial therapy within 4 h of arrival is a critical determinant of survival in patients with bacteraemic pneumococcal CAP.

Community-acquired pneumonia as an emergency: time for an aggressive intervention to lower mortality

“…In fact, the risk of inadequate PERSPECTIVE: COMMUNITY-ACQUIRED PNEUMONIA S. EWIG AND A. TORRES diagnosis can be eliminated if there is a pathway that ensures rapid diagnostic work-up. There is a good reason to establish immediate antimicrobial treatment within a defined timescale after the diagnosis of CAP has radiographically been confirmed [38,39,46,47]. However, the exact duration of the timescale is not yet determined.…”

Bacteraemia and antibiotic-resistant pathogens in community acquired pneumonia: risk and prognosis

“…Recent studies did not consistently find an association between pneumococcal bacteraemia and mortality [4]. The reason may be that other factors, such as time to the first dose of antibiotics and discordant therapy, are more important determinants of prognosis [5]. The association between mortality and bacteraemic CAP caused by microorganisms other than S. pneumoniae is less well-studied.…”

Antipyretic effect of dexamethasone in community-acquired pneumonia

“…The cornerstones of treatment for community-acquired pneumonia (CAP) are early diagnosis and initiation of appropriate antibiotic therapy [1]. Despite prevention with vaccination, and optimal antibiotic treatment, CAP is associated with high mortality and morbidity and significant healthcare costs [2,3].…”