title: Risk factors and pathogenic significance of bacteremic pneumonia in adult patients with community-acquired pneumococcal pneumonia.
abstract: OBJECTIVE
  This study was performed to identify risk factors for the development of bacteremic pneumonia and to evaluate the impact of bacteremia on the outcome of pneumococcal pneumonia.
  
  
  METHODS
  Using a database from a surveillance study of community-acquired pneumococcal pneumonia, we compared data of the bacteremic group with that of the non-bacteremic group.
  
  
  RESULTS
  Among 981 adult patients with pneumococcal pneumonia, 114 (11.6%) patients who had documented pneumococcal bacteremia were classified into the bacteremic group. In a multivariable analysis, use of immunosuppressant drugs, younger age (<65 years), and DM were independent risk factors associated with the development of bacteremic pneumonia among patients with pneumococcal pneumonia (all P < 0.05). The mortality rate was significantly higher in the bacteremic group than in the non-bacteremic group (28.6% vs. 8.5%; P < 0.001). The multivariable analysis revealed that concomitant bacteremia was one of the significant risk factors associated with mortality (OR, 2.57; 95% CI, 1.24-5.29), along with cerebrovascular disease and presentation with septic shock (all P < 0.05).
  
  
  CONCLUSIONS
  Bacteremia was a common finding in pneumococcal pneumonia and was associated with a higher mortality rate. Several clinical variables may be useful for predicting bacteremic pneumonia among patients with pneumococcal pneumonia.
authors.affiliation: Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors.forename: Cheol-In
authors.initials: CI
authors.lastname: Kang
authors.forename: Jae-Hoon
authors.initials: JH
authors.lastname: Song
authors.forename: So Hyun
authors.initials: SH
authors.lastname: Kim
authors.forename: Doo Ryeon
authors.initials: DR
authors.lastname: Chung
authors.forename: Kyong Ran
authors.initials: KR
authors.lastname: Peck
authors.forename: Visanu
authors.initials: V
authors.lastname: Thamlikitkul
authors.forename: Hui
authors.initials: H
authors.lastname: Wang
authors.forename: Thomas Man-kit
authors.initials: TM
authors.lastname: So
authors.forename: Po-Ren
authors.initials: PR
authors.lastname: Hsueh
authors.forename: Rohani Md
authors.initials: RM
authors.lastname: Yasin
authors.forename: Celia C
authors.initials: CC
authors.lastname: Carlos
authors.forename: Pham Hung
authors.initials: PH
authors.lastname: Van
authors.forename: Jennifer
authors.initials: J
authors.lastname: Perera
mesh_terms: D000368:Aged; D001208:Asia / Q000453:epidemiology; D016470:Bacteremia / Q000453:epidemiology / Q000382:microbiology*; D016009:Chi-Square Distribution; D017714:Community-Acquired Infections / Q000453:epidemiology / Q000382:microbiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011018:Pneumonia, Pneumococcal / Q000453:epidemiology / Q000382:microbiology*; D011446:Prospective Studies; D012307:Risk Factors; D013296:Streptococcus pneumoniae / Q000302:isolation & purification*