title: Risk factors for respiratory failure in pneumococcal pneumonia: the importance of pneumococcal serotypes.
abstract: Pneumococcal serotypes are one of the main determinants of pneumococcal disease severity; however, data about their implication in respiratory failure are scarce. We conducted an observational study of adults hospitalised with invasive pneumococcal pneumonia to describe the host- and pathogen-related factors associated with respiratory failure. Of 1258 adults with invasive pneumococcal disease, 615 (48.9%) had respiratory failure at presentation. Patients with respiratory failure were older (62.1 years versus 55.4 years, p<0.001) and had a greater proportion of comorbid conditions. They also had a greater proportion of septic shock (41.7% versus 6.1%, p<0.001), required admission to the intensive care unit more often (38.4% versus 4.2%, p<0.001) and had a higher mortality (25.5% versus 3.5%, p<0.001). After adjustment, independent risk factors for respiratory failure were: age >50 years (OR 1.63, 95% CI 1.15-2.3), chronic lung disease (OR 1.54, 95% CI 1.1-2.15), chronic heart disease (OR 1.49, 95% CI 1.01-2.22) and infection caused by serotypes 3 (OR 1.97, 95% CI 1.23-3.16), 19A (OR 2.34, 95% CI 1.14-4.42) and 19F (OR 3.55, 95% CI 1.22-10.28). In conclusion, respiratory failure is a frequent complication of pneumococcal pneumonia and causes high morbidity and mortality. Pneumococcal serotypes 3, 19A and 19F are the main risk factors for this complication.
authors.affiliation: Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona.
authors.forename: Joaquín
authors.initials: J
authors.lastname: Burgos
authors.forename: Manel
authors.initials: M
authors.lastname: Luján
authors.forename: Maria Nieves
authors.initials: MN
authors.lastname: Larrosa
authors.forename: Dionísia
authors.initials: D
authors.lastname: Fontanals
authors.forename: Guadalupe
authors.initials: G
authors.lastname: Bermudo
authors.forename: Ana Maria
authors.initials: AM
authors.lastname: Planes
authors.forename: Mireia
authors.initials: M
authors.lastname: Puig
authors.forename: Jordi
authors.initials: J
authors.lastname: Rello
authors.forename: Vicenç
authors.initials: V
authors.lastname: Falcó
authors.forename: Albert
authors.initials: A
authors.lastname: Pahissa
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D022242:Pneumococcal Vaccines; D011018:Pneumonia, Pneumococcal / Q000150:complications* / Q000382:microbiology; D012131:Respiratory Insufficiency / Q000150:complications* / Q000382:microbiology / Q000401:mortality; D012307:Risk Factors; D012703:Serotyping; D012772:Shock, Septic; D013030:Spain; D013296:Streptococcus pneumoniae / Q000145:classification*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D022242:Pneumococcal Vaccines