title: Impact of bacteremia in a cohort of patients with pneumococcal pneumonia.
abstract: OBJECTIVE
  Bacteremia is the most common presentation of invasive disease in community-acquired pneumonia (CAP) due to Streptococcus pneumoniae. We investigated whether bacteremia in pneumococcal CAP worsens outcomes and whether it is related to pneumococcal vaccination (PV).
  
  
  METHODS
  Secondary analysis of a cohort of patients with pneumococcal CAP confirmed by blood culture, sputum culture, or urinary antigen testing. Demographic, clinical, radiographic, and biochemical data were collected, as were Acute Physiology and Chronic Health Evaluation II (APACHE II) and pneumonia severity index (PSI) scores, comorbidities, and PV history. We drew comparisons between patients with bacteremic pneumococcal CAP (BPP) and those with non-bacteremic pneumococcal CAP (NBPP).
  
  
  RESULTS
  Forty-seven patients had BPP, and 71 had NBPP (confirmed by sputum culture in 45 and by urinary antigen testing in 26); 107 had some indication for PV. None of the BPP patients had received PV, compared with 9 of the NBPP patients (p = 0.043). Among the BPP patients, the mean age was higher (76.4 ± 11.5 vs. 67.5 ± 20.9 years), as were APACHE II and PSI scores (16.4 ± 4.6 vs. 14.1 ± 6.5 and 129.5 ± 36 vs. 105.2 ± 45, respectively), as well as the rate of ICU admission for cardiopathy or chronic renal failure (42.5% vs. 22.5%), whereas hematocrit and plasma sodium levels were lower (35.7 ± 5.8 vs. 38.6 ± 6.7% and 133.9 ± 6.0 vs. 137.1 ± 5.5 mEq/L, respectively), although mortality was similar (29.8% vs. 28.2%).
  
  
  CONCLUSIONS
  In this population at high risk for CAP due to S. pneumoniae, the PV rate was extremely low (8.4%). Although BPP patients were more severely ill, mortality was similar between the two groups. Because PV reduces the incidence of BPP, the vaccination rate in at-risk populations should be increased.
authors.affiliation: División de Neumología, Hospital de Clínicas, Universidad de Buenos Aires, Buenos Aires, Argentina.
authors.forename: Ileana
authors.initials: I
authors.lastname: Palma
authors.forename: Ricardo
authors.initials: R
authors.lastname: Mosquera
authors.forename: Carmen
authors.initials: C
authors.lastname: Demier
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Vay
authors.forename: Angela
authors.initials: A
authors.lastname: Famiglietti
authors.forename: Carlos M
authors.initials: CM
authors.lastname: Luna
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001118:Argentina / Q000453:epidemiology; D016470:Bacteremia / Q000382:microbiology / Q000401:mortality*; D017714:Community-Acquired Infections / Q000382:microbiology / Q000401:mortality; D004812:Epidemiologic Methods; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay; D008297:Male; D022242:Pneumococcal Vaccines / Q000627:therapeutic use; D018410:Pneumonia, Bacterial / Q000382:microbiology / Q000401:mortality; D011018:Pneumonia, Pneumococcal / Q000150:complications / Q000401:mortality* / Q000517:prevention & control
chemical_list: D022242:Pneumococcal Vaccines