title: Prospective study of prognostic factors in community-acquired bacteremic pneumococcal disease in 5 countries.
abstract: To define the influence of prognostic factors in patients with community-acquired pneumococcal bacteremia, a 2-year prospective study was performed in 5 centers in Canada, the United States, the United Kingdom, Spain, and Sweden. By multivariate analysis, the independent predictors of death among the 460 patients were age >65 years (odds ratio [OR], 2.2), living in a nursing home (OR, 2.8), presence of chronic pulmonary disease (OR, 2.5), high acute physiology score (OR for scores 9-14, 7.6; for scores 15-17, 22; and for scores >17, 41), and need for mechanical ventilation (OR, 4.4). Of patients with meningitis, 26% died. Of patients with pneumonia without meningitis, 19% of those with >/=2 lobes and 7% of those with only 1 lobe involved (P=.0016) died. The case-fatality rate differed significantly among the centers: 20% in the United States and Spain, 13% in the United Kingdom, 8% in Sweden, and 6% in Canada. Differences of disease severity and of frequencies and impact of underlying chronic conditions were factors of probable importance for different outcomes.
authors.affiliation: Department of Medicine, Section of Infectious Diseases, Karolinska Hospital, 171 76 Stockholm, Sweden. kal@ks.se
authors.forename: M
authors.initials: M
authors.lastname: Kalin
authors.forename: A
authors.initials: A
authors.lastname: Ortqvist
authors.forename: M
authors.initials: M
authors.lastname: Almela
authors.forename: E
authors.initials: E
authors.lastname: Aufwerber
authors.forename: R
authors.initials: R
authors.lastname: Dwyer
authors.forename: B
authors.initials: B
authors.lastname: Henriques
authors.forename: C
authors.initials: C
authors.lastname: Jorup
authors.forename: I
authors.initials: I
authors.lastname: Julander
authors.forename: T J
authors.initials: TJ
authors.lastname: Marrie
authors.forename: M A
authors.initials: MA
authors.lastname: Mufson
authors.forename: R
authors.initials: R
authors.lastname: Riquelme
authors.forename: A
authors.initials: A
authors.lastname: Thalme
authors.forename: A
authors.initials: A
authors.lastname: Torres
authors.forename: M A
authors.initials: MA
authors.lastname: Woodhead
mesh_terms: D000368:Aged; D016470:Bacteremia / Q000503:physiopathology / Q000635:transmission*; D002170:Canada; D017714:Community-Acquired Infections / Q000382:microbiology* / Q000503:physiopathology; D006801:Humans; D015999:Multivariate Analysis; D011008:Pneumococcal Infections / Q000503:physiopathology / Q000635:transmission*; D011379:Prognosis; D013030:Spain; D013548:Sweden; D006113:United Kingdom; D014481:United States