Bacteremic pneumococcal pneumonia: serotype distribution, antimicrobial susceptibility, severity scores, risk factors, and mortality in a single center in Chile

Brazilian Journal of Infectious Diseases

Benavides, María Guacolda¹  Bunster, Nicolás¹  Aliaga, Felipe¹  Porte, Lorena¹  Braun, Stephanie¹  Fica, Alberto¹  Hernández, Antonio¹  Hormázabal, Juan Carlos²  Dabanch, Jeannette¹  Olivares, Felipe¹ 

[1] Hospital Militar de Santiago, Chile;Instituto de Salud Pública, Chile

关键词: Streptococcus pneumoniae;    Bacteremia;    Serotyping;    Microbial drug resistance;    Risk factors;    Mortality;    Elderly;    CURB-65;    APACHE II;    PIROIntroductionInvasive infections due to Streptococcus pneumoniae are an important cause or morbidity and mortality with a high disease burden;   

DOI  :  10.1016/j.bjid.2013.06.001

来源: Contexto

【 摘 要 】

AIMS:Bacteremic pneumococcal pneumonia (BPP) is a severe condition. To evaluate seasonal distribution, mortality, serotype frequencies, antimicrobial susceptibility, and different severity scores among patients with BPP. PATIENTS AND METHODS:Patients were identified by laboratory data and restricted to adulthood. Standard methods were used for serotyping and antimicrobial susceptibility. Risk factors were analyzed by univariate and multivariate methods. Severity scores (APACHE II, CURB-65 and CAP PIRO) were compared using ROC curves. RESULTS:Sixty events of community-acquired BPP occurred between 2005 and 2010. A seasonal pattern was detected. Mean age was 72.1 years old (81.4% >60 years). All had a predisposing factor. Previous influenza (3.3%) or pneumococcal immunization (1.7%) was infrequent. Admission to critical units was required by 51.7%. Twenty-two serotypes were identified among 59 strains. Only one strain had intermediate resistance to penicillin (1.7%). In-hospital mortality reached 33.3%. Multivariate analysis identified a CAP PIRO score>3 (OR 29.7; IC95 4.7-187), age >65 years (OR 42.1; IC95 2.2-796), and a platelet count<100,000/μL (OR 10.9; IC95 1.2-96) as significant independent factors associated with death. ROC curve analysis did not reveal statistical differences between the three severity scores to predict death (AUC 0.77-0.90). The prognostic yield for all of them was limited (Positive Likelihood Ratio: 1.5-3.8). CONCLUSIONS:BPP had a high case-fatality rate in this group of adult patients with no association to resistant isolates, and a low immunization record. Three independent factors were related to death and the prognostic yield of different severity scores was low.

【 授权许可】

Unknown