Impact of bacterial coinfection on clinical outcomes in pneumococcal pneumonia

Abstract

The aim of this study was to investigate the influence of bacterial coinfection on patients with pneumococcal pneumonia. We retrospectively analyzed the incidence, clinical features, microbial distributions, and outcomes of patients with bacterial coinfection in a cohort of 433 hospitalized patients with pneumococcal pneumonia. Eighty-five patients (19.6 %) were diagnosed with bacterial coinfection; the most frequent pathogens were Haemophilus influenzae (25 patients, 33.3 %), methicillin-susceptible Staphylococcus aureus (MSSA) (15 patients, 20.0 %), and Moraxella catarrhalis (13 patients, 17.3 %). The CURB-65 score and pneumonia severity index (PSI) were significantly higher in patients with bacterial coinfection (both P < 0.001). In addition, the proportion of patients with bacterial coinfection who met the Infectious Disease Society of America (IDSA)/American Thoracic Society (ATS) severe pneumonia criteria was significantly higher (P < 0.001). Multivariate logistic regression analysis identified three risk factors for bacterial coinfection in patients with pneumococcal pneumonia: alcoholism (odds ratio [OR], 5.12; 95 % confidence interval (95 % CI), 1.60-16.4; P = 0.006), hospitalization for 2 days or more within 90 days preceding admission (OR, 2.02; 95 % CI, 1.03-3.98; P = 0.041), and residence in a nursing home or extended care facility (OR, 3.22; 95 % CI, 1.48-6.97; P = 0.003). Multivariate analysis for 30-day mortality showed that bacterial coinfection was a significant adverse prognostic factor (OR, 2.50; 95 % CI, 1.13-5.53; P = 0.023), independent of IDSA/ATS severe pneumonia, PSI, or healthcare-associated pneumonia. In conclusion, bacterial coinfection may have an adverse impact on severity and outcomes of pneumococcal pneumonia.

Influence of Older Age and Other Risk Factors on Pneumonia Hospitalization in Switzerland in the Pneumococcal Vaccine Era

“…Since microbiological diagnoses are neither reliably coded, identified, or even attempted we did not separately analyse episodes of pneumonia due to organisms other than pneumococcus. We also included codes of bacterial pneumonia with other pathogens than pneumococcus given the low sensitivity of pneumococcal etiologic diagnosis (25, 26) and the possibility of undetected coinfection with pneumococcus (27). Our subgroup analysis of only those hospitalizations with pneumococcal pneumonia increased the diagnostic specificity of this vaccine-preventable disease, whereas there is certainly considerably underreporting and therefore decreased sensitivity with this analysis.…”

Mortalidad hospitalaria de las infecciones respiratorias comunitarias y asociadas a cuidados socio-sanitarios: una revisión sistemática

“…Los resultados obtenidos podrían estar influidos por el hecho de que en las bases de datos consultadas no se incluyen todos los tipos de publicaciones disponibles sobre el objeto de estudio abordado en este caso. Sin embargo, se han explorado las que de alguna forma resultan fundamentales, tanto para las ciencias de la salud como para la investigación que se desarrolla en Europa 14,[17][18][19] , América 11,13,15 , Asia 12,16 y Australia 20 . Por tanto, podría decirse que se ha realizado una búsqueda lo suficientemente exhaustiva como para poder, al menos, establecer una aproximación a nuestro objetivo.…”

“…En cuanto a la edad media que presentan los pacientes con infección respiratoria, en la mayoría de los artículos es mayor de 60 años 12,13,15,17,[18][19][20] , excepto en tres estudios 11,14,16 con medias de edad entre 42 y 57 años. El estudio con la media de edad más baja fue realizado en Vietnam donde la proporción de personas mayores es menor que en otros países occidentales, lo que podría explicar esta diferencia de media al compararlo con otros estudios 16 .…”

Simultaneous Detection of Key Bacterial Pathogens Related to Pneumonia and Meningitis Using Multiplex PCR Coupled With Mass Spectrometry

“…Mixed infections have been reported by different groups, with the rate of bacterial coinfection varying from 13% to approximately 33%; the most common combination is S. pneumoniae and H. influenzae (de Roux et al, 2006 ; Cilloniz et al, 2011b ; Musher et al, 2017 ). Bacterial coinfection is associated with severe disease and high mortality rates, so timely discovery of mixed etiologies is critical for antimicrobial treatment and clinical outcomes (Cilloniz et al, 2011a , b ; Kumagai et al, 2015 ). In our study, S. pneumoniae and H. influenzae were the most frequently identified coinfection bacteria, but multiple infections were found in 45.6% (93/204) of samples, which is higher than the percentage determined in other studies.…”