Bacteremic pneumococcal pneumonia: serotype distribution, antimicrobial susceptibility, severity scores, risk factors, and mortality in a single center in Chile
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 restrict...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2014-03-01
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| Series: | Brazilian Journal of Infectious Diseases |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1413867013002328 |
| _version_ | 1819159845589221376 |
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| author | Alberto Fica Nicolás Bunster Felipe Aliaga Felipe Olivares Lorena Porte Stephanie Braun Jeannette Dabanch Juan Carlos Hormázabal Antonio Hernández María Guacolda Benavides |
| author_facet | Alberto Fica Nicolás Bunster Felipe Aliaga Felipe Olivares Lorena Porte Stephanie Braun Jeannette Dabanch Juan Carlos Hormázabal Antonio Hernández María Guacolda Benavides |
| author_sort | Alberto Fica |
| collection | DOAJ |
| description | 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. Keywords: Streptococcus pneumoniae, Bacteremia, Serotyping, Microbial drug resistance, Risk factors, Mortality, Elderly, CURB-65, APACHE II, PIRO |
| first_indexed | 2024-12-22T16:47:02Z |
| format | Article |
| id | doaj.art-58980144d6994dbb9a0d717fb370e20b |
| institution | Directory Open Access Journal |
| issn | 1413-8670 |
| language | English |
| last_indexed | 2024-12-22T16:47:02Z |
| publishDate | 2014-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Brazilian Journal of Infectious Diseases |
| spelling | doaj.art-58980144d6994dbb9a0d717fb370e20b2022-12-21T18:19:43ZengElsevierBrazilian Journal of Infectious Diseases1413-86702014-03-01182115123S1413-86702014000200115Bacteremic pneumococcal pneumonia: serotype distribution, antimicrobial susceptibility, severity scores, risk factors, and mortality in a single center in ChileAlberto Fica0Nicolás Bunster1Felipe Aliaga2Felipe Olivares3Lorena Porte4Stephanie Braun5Jeannette Dabanch6Juan Carlos Hormázabal7Antonio Hernández8María Guacolda Benavides9Servicio de Infectología, Hospital Militar de Santiago, Chile; Corresponding author at: Servicio de Infectología, Hospital Militar de Santiago, Av. Larraín 9100, La Reina, Santiago, Chile.Unidad Coronaria, Hospital Militar de Santiago, ChileUnidad de Pacientes Críticos, Hospital Militar de Santiago, ChileResidente Medicina Interna, Hospital Militar de Santiago, ChileLaboratorio de Microbiología, Hospital Militar de Santiago, ChileLaboratorio de Microbiología, Hospital Militar de Santiago, ChileServicio de Infectología, Hospital Militar de Santiago, ChileSubdepartamento de Microbiología, Instituto de Salud Pública, ChileUnidad de Pacientes Críticos, Hospital Militar de Santiago, ChileServicio de Enfermedades Respiratorias, Hospital Militar de Santiago, ChileAims: 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. Keywords: Streptococcus pneumoniae, Bacteremia, Serotyping, Microbial drug resistance, Risk factors, Mortality, Elderly, CURB-65, APACHE II, PIROhttp://www.sciencedirect.com/science/article/pii/S1413867013002328 |
| spellingShingle | Alberto Fica Nicolás Bunster Felipe Aliaga Felipe Olivares Lorena Porte Stephanie Braun Jeannette Dabanch Juan Carlos Hormázabal Antonio Hernández María Guacolda Benavides Bacteremic pneumococcal pneumonia: serotype distribution, antimicrobial susceptibility, severity scores, risk factors, and mortality in a single center in Chile Brazilian Journal of Infectious Diseases |
| title | Bacteremic pneumococcal pneumonia: serotype distribution, antimicrobial susceptibility, severity scores, risk factors, and mortality in a single center in Chile |
| title_full | Bacteremic pneumococcal pneumonia: serotype distribution, antimicrobial susceptibility, severity scores, risk factors, and mortality in a single center in Chile |
| title_fullStr | Bacteremic pneumococcal pneumonia: serotype distribution, antimicrobial susceptibility, severity scores, risk factors, and mortality in a single center in Chile |
| title_full_unstemmed | Bacteremic pneumococcal pneumonia: serotype distribution, antimicrobial susceptibility, severity scores, risk factors, and mortality in a single center in Chile |
| title_short | Bacteremic pneumococcal pneumonia: serotype distribution, antimicrobial susceptibility, severity scores, risk factors, and mortality in a single center in Chile |
| title_sort | bacteremic pneumococcal pneumonia serotype distribution antimicrobial susceptibility severity scores risk factors and mortality in a single center in chile |
| url | http://www.sciencedirect.com/science/article/pii/S1413867013002328 |
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