Risk factors and pathogenic significance of bacteremic pneumonia in adult patients with community-acquired pneumococcal pneumonia

• Published in: The Journal of infection Vol. 66; no. 1; pp. 34 - 40
• Main Authors: Kang, Cheol-In, Song, Jae-Hoon, Kim, So Hyun, Chung, Doo Ryeon, Peck, Kyong Ran, Thamlikitkul, Visanu, Wang, Hui, So, Thomas Man-kit, Hsueh, Po-Ren, Yasin, Rohani Md, Carlos, Celia C, Van, Pham Hung, Perera, Jennifer
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier Ltd 01.01.2013; Elsevier
• Subjects: Age; Aged; Asia - epidemiology; Bacteremia; Bacteremia - epidemiology; Bacteremia - microbiology; Bacterial diseases; Bacterial sepsis; Biological and medical sciences; Cerebrovascular diseases; Chi-Square Distribution; Community-Acquired Infections - epidemiology; Community-Acquired Infections - microbiology; Community-acquired pneumonia; Data processing; Drug development; Drugs; Female; General aspects; Human bacterial diseases; Humans; Immunosuppressive agents; Infectious Disease; Infectious diseases; Male; Medical sciences; Middle Aged; Mortality; Multivariate Analysis; Pneumology; Pneumonia; Pneumonia, Pneumococcal - epidemiology; Pneumonia, Pneumococcal - microbiology; Prospective Studies; Respiratory system : syndromes and miscellaneous diseases; Risk Factors; Septic shock; Streptococcus pneumoniae; Streptococcus pneumoniae - isolation & purification; Treatment outcome; Asia; Treatment outcome; Community-acquired pneumonia; Bacteremia; Risk factors; Streptococcus pneumoniae; Human; Lung disease; Pneumonia; Respiratory disease; Infection; Streptococcaceae; Community acquired infection; Streptococcal infection; Risk factor; Bacteriosis; Bacteria; Micrococcales; Adult; Pneumococcal infection
• ISSN: 0163-4453; 1532-2742
• DOI: 10.1016/j.jinf.2012.08.011

Summary Objective This study was performed to identify risk factors for the development of bacteremic pneumonia and to evaluate the impact of bacteremia on the outcome of pneumococcal pneumonia. Methods Using a database from a surveillance study of community-acquired pneumococcal pneumonia, we compared data of the bacteremic group with that of the non-bacteremic group. Results Among 981 adult patients with pneumococcal pneumonia, 114 (11.6%) patients who had documented pneumococcal bacteremia were classified into the bacteremic group. In a multivariable analysis, use of immunosuppressant drugs, younger age (<65 years), and DM were independent risk factors associated with the development of bacteremic pneumonia among patients with pneumococcal pneumonia (all P  < 0.05). The mortality rate was significantly higher in the bacteremic group than in the non-bacteremic group (28.6% vs. 8.5%; P  < 0.001). The multivariable analysis revealed that concomitant bacteremia was one of the significant risk factors associated with mortality (OR, 2.57; 95% CI, 1.24–5.29), along with cerebrovascular disease and presentation with septic shock (all P  < 0.05). Conclusions Bacteremia was a common finding in pneumococcal pneumonia and was associated with a higher mortality rate. Several clinical variables may be useful for predicting bacteremic pneumonia among patients with pneumococcal pneumonia.