Impact of positive chest X-ray findings and blood cultures on adverse outcomes following hospitalized pneumococcal lower respiratory tract infection: a population-based cohort study

Abstract

BackgroundLittle is known about the clinical presentation and outcome of pneumococcal lower respiratory tract infection (LRTI) without positive chest X-ray findings and blood cultures. We investigated the prognostic impact of a pulmonary infiltrate and bacteraemia on the clinical course of hospitalized patients with confirmed pneumococcal LRTI.MethodsWe studied a population-based multi-centre cohort of 705 adults hospitalized with LRTI and Streptococcus pneumoniae in LRT specimens or blood: 193 without pulmonary infiltrate or bacteraemia, 250 with X-ray confirmed pneumonia, and 262 with bacteraemia. We compared adverse outcomes in the three groups and used multiple regression analyses to adjust for differences in age, sex, comorbidity, and lifestyle factors.ResultsPatients with no infiltrate and no bacteraemia were of similar age but had more comorbidity than the other groups (Charlson index score ≥1: no infiltrate and no bacteraemia 81% vs. infiltrate without bacteraemia 72% vs. bacteraemia 61%), smoked more tobacco, and had more respiratory symptoms. In contrast, patients with a pulmonary infiltrate or bacteraemia had more inflammation (median C-reactive protein: no infiltrate and no bacteraemia 82 mg/L vs. infiltrate without bacteraemia 163 mg/L vs. bacteraemia 316 mg/L) and higher acute disease severity scores. All adverse outcomes increased from patients with no infiltrate and no bacteraemia to those with an infiltrate and to those with bacteraemia: Length of hospital stay (5 vs. 6 vs. 8 days); intensive care admission (7% vs. 20% vs. 23%); pulmonary complications (1% vs. 5% vs. 14%); and 30-day mortality (5% vs. 11% vs. 21%). Compared with patients with no infiltrate and no bacteraemia, the adjusted 30-day mortality rate ratio was 1.9 (95% confidence interval (CI) 0.9-4.1) in patients with an infiltrate without bacteraemia and 4.1 (95% CI 2.0-8.5) in bacteraemia patients. Adjustment for acute disease severity and inflammatory markers weakened these associations.ConclusionsHospitalization with confirmed pneumococcal LRTI is associated with substantial morbidity and mortality even without positive chest X-ray findings and blood cultures. Still, there is a clinically important outcome gradient from LRTI patients with pneumococcal isolation only to those with detected pulmonary infiltrate or bacteraemia which is partly mediated by higher acute disease severity and inflammation.

Pneumococcal pneumonia infection is associated with end-stage renal disease in adult hospitalized patients

“…Finally, we use the discontinuity of national health insurance as a proxy measure of death for the mortality calculation. The possible reasons for the discontinuity of national health insurance include the following: (1) death (major proportions, with a high 30-day mortality rate among hospitalized PP patients ranging from 11 to 21% 39,40 ); (2) prison sentence and immigration (a few cases); and (3) withdrawal from the insurance system (a few cases, as the health insurance coverage rate was B99% in 2012). Although we believe that death would be the major reason, the mortality would still be overestimated.…”

Etiologic Diagnosis and Clinical Treatment of Multiple Drug-Resistant Bacteria Infection in Elderly Patients with Stroke-Associated Pneumonia After Neurosurgery

“…In recent years, patients in Neurosurgery Department, especially elderly patients, are liable to have lung infection due to the weakened defense function of respiratory tract and reduced immunity [1][2][3]. The incidence rate of stroke-associated pneumonia [4][5][6] is high in patients from Neurosurgery Department, which prolongs the hospitalization time and significantly affects the prognosis [7][8][9] of patients.…”

Pneumokokkeninfektionen – was gibt es Neues?

“…So stieg in einer spanischen Studie mit der Konzentration von Pneumokokken-DNA im Blut auch das Risiko für die Entwicklung eines septischen Schocks, Lungenversagen und Tod [25]. In mehreren Kohortenstudien weisen Patienten mit bakteriämischer Pneumokokken-CAP eine höhere Sterblichkeit auf als Patienten mit nicht-bakteriämischer Pneumokokken-CAP [20,30]. Dagegen korrelierte der Nachweis von Pneumokokken in der Blutkultur in der CAPNETZ-Studie nicht mit der Sterblichkeit [23].…”