[Community acquired pneumococcal pneumonia in hospitalized adult patients].
BACKGROUND
S pneumoniae is the most common cause of community-acquired pneumonia.


OBJECTIVE
To evaluate the clinical characteristics, antibiotic resistance, management and prognostic factors in pneumococcal pneumonia.


METHODS
Prospective evaluation in 46 adults (age +/- sd: 68 +/- 17 years) hospitalized with pneumococcal pneumonia confirmed by sputum, blood or pleural fluid cultures. Clinical and radiographic variables, risk factors for antibiotic resistance, and hospital mortality rate were recorded.


RESULTS
Heart disease (39%), COPD/asthma (25%), and diabetes mellitus (18%) were the most frequent underlying diseases. None of the patients had previously received pneumococcal vaccine. Only 17% of the patients had the classic triad of chills, fever and productive cough. At admission, interestingly, 17% presented with congestive heart failure. Resistance of pneumococci to penicillin, cefotaxime or erythromycin was 15%, 6% and 11%, respectively. Antibiotic use prior to admission was significantly associated with antibiotic resistance (OR = 6; CI 95% = 1.1-32; p < 0.05). Fifty per cent of the patients were admitted to intermediate or intensive care units, 15% were mechanically ventilated, 20% developed septic shock, 20% developed acute renal failure and 13% died in the hospital. Clinical factors significantly associated with higher mortality were systolic hypotension (< or = 90 mmHg), ICU admission and BUN > 30 mg per dL.


CONCLUSIONS
Our data suggest that pneumococcal pneumonia is still a severe infection with high mortality; hence, efforts should be made at prevention using pneumococcal immunization.
Díaz
Alejandro
A
Departamentos de Enfermedades Respiratorias, Facultad de Medicina, Pontificia Universidad Católica de Chile, Marcoleta 345, 4o Piso, Santiago, Chile. alediazf@hotmail.com
Torres
Catalina
C
Flores
Luis José
LJ
García
Patricia
P
Saldías
Fernando
F
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002677:Chile / Q000453:epidemiology; D017714:Community-Acquired Infections / Q000150:complications / Q000188:drug therapy / Q000401:mortality; D015897:Comorbidity; D024881:Drug Resistance, Bacterial; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D016867:Immunocompromised Host; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010403:Penicillin Resistance; D011018:Pneumonia, Pneumococcal / Q000150:complications / Q000188:drug therapy / Q000401:mortality*; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D016019:Survival Analysis