Twenty-year trend in mortality among hospitalized patients with pneumococcal community-acquired pneumonia

Abstract

BackgroundThere is only limited information on mortality over extended periods in hospitalized patients with pneumococcal community-acquired pneumonia (CAP). We aimed to evaluate the 30-day mortality and whether is changed over a 20-year period among immunocompetent adults hospitalized with pneumococcal CAP.MethodsWe conducted a retrospective observational study of data that were prospectively collected at the Hospital Clinic of Barcelona of all adult patients hospitalized with diagnosis of pneumococcal CAP over a 20-year period. To aid analysis, results were divided into four periods of 5 years each (1997–2001, 2002–2006, 2007–2011, 2012–2016). The primary outcome was 30-day mortality, but secondary outcomes included intensive care unit (ICU) admission, lengths of hospital and ICU-stays, ICU-mortality, and need of mechanical ventilation.ResultsFrom a cohort of 6,403 patients with CAP, we analyzed the data for 1,120 (17%) adults with a diagnosis of pneumococcal CAP. Over time, we observed decreases in the rates of alcohol consumption, smoking, influenza vaccination, and older patients (age ≥65 years), but increases in admissions to ICU and the need for non-invasive mechanical ventilation. The overall 30-day mortality rate was 8% (95% confidence interval, 6%–9%; 84 of 1,120 patients) and did not change significantly between periods (p = 0.33). Although, we observed a decrease in ICU-mortality comparing the first period (26%) to the second one (10%), statistical differences disappeared with adjustment (p0.38).ConclusionOver time, 30-day mortality of hospitalized pneumococcal CAP did not change significantly. Nor did it change in the propensity-adjusted multivariable analysis. Since mortality in pneumococcal pneumonia has remained unaltered for many years despite the availability of antimicrobial agents with proven in vitro activity, other non-antibiotic strategies should be investigated.

Shen-ling-bai-zhu-san ameliorates inflammation and lung injury by increasing the gut microbiota in the murine model of Streptococcus pneumonia-induced pneumonia

“…Pneumonia, which is an inflammatory disease caused by bacteria, viruses, fungi, or other microorganisms, mainly affects children and the elderly and has high morbidity and mortality worldwide, and the morbidity and mortality of pneumonia is increasing [1][2][3]. Streptococcus pneumoniae (Spn), a gram-positive bacterium with over 90 serotypes, is the most common bacterial pneumoniacausing pathogen [4].…”

The Role of Streptococcus pneumoniae in Community-Acquired Pneumonia

“…A recent retrospective observational study in Barcelona, Spain, of hospitalized patients with pneumococcal pneumonia, conducted over a period of 20 years between 1997 and 2016, which was divided into four 5-year periods, noted that the 30-day mortality rate was 8% and did not change significantly between periods. 163 There was an increase in admissions to ICU and need for mechanical ventilation, and although the ICU mortality decreased between periods one and two, there was no significant difference with adjustments. Even in the propensity-adjusted multivariate analysis, 30-day mortality did not change.…”

“…164 Most studies such as these in pneumococcal CAP, as well as many others in all-cause CAP, have arbitrarily examined short-term mortality in those patients, such as hospital mortality or 30-day mortality. [163][164][165] It is only more recently that long-term mortality rates in patients with CAP have been investigated. These studies have revealed an unacceptably high long-term mortality, such that an episode of CAP is associated with a higher risk of long-term adverse events in comparison with age-matched subjects in the general population who have not suffered an episode of CAP.…”

Characteristics and outcomes among a hospitalized patient cohort with Streptococcus pneumoniae infection

“…Developing new prevention strategies and treatment paradigms for SP infections is critical given the lack of mortality improvement with this infection over the past twenty years. [ 41 ]…”