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Importance of pneumococcal bacteraemia for severity scoring in community-acquired pneumonia

Abstract number: R2524

Strålin K., Holmberg H.

Objective: The severity rules pneumonia severity index (PSI) and CURB-65 are widely used for severity assessment in community-acquired pneumonia (CAP). We aimed to compare the performances of these rules in CAP patients with and without pneumococcal bacteraemia.

Methods: The records of all patients hospitalised at our 35-bed clinic with a discharge code of pneumonia during a 4-year period were retrospectively screened. Patients with chest X-ray infiltrates, at least two symptoms indicating pneumonia, and no hospitalisation during the preceding month were considered to have CAP. The CAP patients who had blood cultures obtained on admission were included in the study. The PSI, CURB-65, and CRB-65 rules were calculated. Data on survival at day 30 from admission was collected from the national population register.

Results: Among 648 CAP patients, who fullfilled the study criteria, 46 patients (7.1%, mean age 65 years) had pneumococcal bacteraemia, while 602 patients (mean age 66 years) had blood cultures that were negative for Streptococcus pneumoniae. The frequencies of comorbid illnesses were similar in the two groups. Death within 30 days was noted in 15% (7/46) of those with and in 4.5% (27/602) of those without pneumococcal bacteraemia (p = 0.002). The table shows the 30-day mortality rates according to different severity scores in the CAP patients with and without pneumococcal bacteraemia.

Death within 30 days and/or admission to intensive care unit (ICU) was noted in 28% (13/46) of those with and in 12% (70/602) of those without pneumococcal bacteraemia (p < 0.001). Death and/or ICU admission among the CAP patients with high severity scores was noted as follows (pneumococcal bacteraemia vs. no pneumococcal bacteraemia): PSI V, 80% (8/10) vs. 35% (22/63, p = 0.013); CURB-65 3–5, 47% (7/15) vs. 23% (27/119, p = 0.044); and CRB-65 2–4, 50% (9/18) vs. 20% (35/176, p = 0.004).

Conclusion: The present study shows that pneumococcal bacteraemia is an important severity factor in CAP. In CAP patients with high severity scores, the outcome appears to be worse in those with than in those without pneumococcal bacteraemia. This knowledge should be borne in mind when severity scores are interpreted in CAP patients with known or suspected pneumococcal bacteraemia.

Session Details

Date: 19/04/2008
Time: 00:00-00:00
Session name: 18th European Congress of Clinical Microbiology and Infectious Diseases
Subject:
Location: Barcelona, Spain
Presentation type:
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