title: Pneumococcal pneumonia: differences according to blood culture results.
abstract: BACKGROUND
  Bacteremia by Streptococcus pneumoniae has been traditionally associated with poor outcomes in patients with pneumonia; however, data on its impact on outcomes are limited and are sometimes contradictory.
  
  
  METHODS
  We performed a prospective study in two hospitals in northern Spain in which cases diagnosed with pneumococcal pneumonia were selected from a cohort of hospitalized patients with pneumonia between January 2001 and July 2009. We compared patients with pneumococcal bacteremic pneumonia with those with pneumococcal non-bacteremic pneumonia.
  
  
  RESULTS
  We compared 492 patients with negative blood culture and 399 with positive culture results. Host related factors were very similar in both groups. Severity of illness on admission measured by CURB-65 score was similar in both groups. Adjusted analysis showed a greater likelihood of septic shock during in-hospital course among patients with pneumococcal bacteremia (OR, 2.1; 95% CI, 1.2-3.5; P=0.006). Likewise, patients with positive blood culture had greater in-hospital mortality (OR 2.1; 95% CI, 1.1- -3.9; P=0.02), 15-day mortality (OR 3.6; 95% CI, 1.7-7.4; P=0.0006), and 30-day mortality (OR, 2.7; 95% CI, 1.5-5; P=0.002).
  
  
  CONCLUSIONS
  Although host related factors and severity on admission were very similar in the two groups, bacteremic patients had worse in-hospital course and outcomes. Bacteraemia in pneumococcal pneumonia is of prognostic significance.
authors.affiliation: Service of Pneumology, Hospital de Galdakao-Usansolo, Galdakao, Bizkaia E-48960, Spain. alberto.capelasteguisaiz@osakidetza.net.
authors.forename: Alberto
authors.initials: A
authors.lastname: Capelastegui
authors.forename: Rafael
authors.initials: R
authors.lastname: Zalacain
authors.forename: Amaia
authors.initials: A
authors.lastname: Bilbao
authors.forename: Mikel
authors.initials: M
authors.lastname: Egurrola
authors.forename: Luis Alberto Ruiz
authors.initials: LA
authors.lastname: Iturriaga
authors.forename: Jose M
authors.initials: JM
authors.lastname: Quintana
authors.forename: Ainhoa
authors.initials: A
authors.lastname: Gomez
authors.forename: Cristobal
authors.initials: C
authors.lastname: Esteban
authors.forename: Pedro P
authors.initials: PP
authors.lastname: España
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000382:microbiology / Q000401:mortality*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011018:Pneumonia, Pneumococcal / Q000150:complications* / Q000401:mortality*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000382:microbiology*; D013030:Spain / Q000453:epidemiology; D013296:Streptococcus pneumoniae / Q000302:isolation & purification*
references.citation: Arch Bronconeumol. 2010 Oct;46(10):543-58
references.pmid: 20832928
references.citation: Chest. 2008 Mar;133(3):618-24
references.pmid: 18198264
references.citation: Respir Med. 2007 Sep;101(9):1845-63
references.pmid: 17544265
references.citation: Eur Respir J. 2008 Sep;32(3):733-9
references.pmid: 18508820
references.citation: Thorax. 2003 May;58(5):377-82
references.pmid: 12728155
references.citation: Medicine (Baltimore). 2008 May;87(3):160-166
references.pmid: 18520325
references.citation: Thorax. 2010 Jan;65(1):77-81
references.pmid: 19996337
references.citation: Thorax. 1995 May;50(5):543-7
references.pmid: 7597669
references.citation: Clin Infect Dis. 2003 Feb 15;36(4):389-95
references.pmid: 12567294
references.citation: Can Respir J. 2003 Oct;10(7):368-74
references.pmid: 14571288
references.citation: Am J Respir Crit Care Med. 2002 Mar 15;165(6):766-72
references.pmid: 11897642
references.citation: J Infect Dis. 2000 Sep;182(3):840-7
references.pmid: 10950779
references.citation: Chest. 1998 Feb;113(2):387-90
references.pmid: 9498956
references.citation: Chest. 1993 Apr;103(4):1152-6
references.pmid: 8131456
references.citation: Chest. 2009 Jan;135(1):165-172
references.pmid: 18689575
references.citation: Am J Respir Crit Care Med. 2003 Jul 1;168(1):77-84
references.pmid: 12702548
references.citation: Clin Infect Dis. 2001 Sep 15;33(6):797-805
references.pmid: 11512085
references.citation: Clin Infect Dis. 2004 Jun 1;38(11):1570-8
references.pmid: 15156445
references.citation: J Gen Intern Med. 2000 Sep;15(9):638-46
references.pmid: 11029678
references.citation: Medicine (Baltimore). 2000 Jul;79(4):210-21
references.pmid: 10941350
references.citation: Eur J Intern Med. 2008 Jan;19(1):15-21
references.pmid: 18206596
references.citation: Crit Care Med. 2003 Apr;31(4):1250-6
references.pmid: 12682500
references.citation: Am J Med. 1999 Jul 26;107(1A):34S-43S
references.pmid: 10451007
references.citation: JAMA. 1996 Jan 10;275(2):134-41
references.pmid: 8531309
references.citation: Arch Intern Med. 1997 Sep 22;157(17):1965-71
references.pmid: 9308508
references.citation: Arch Surg. 1998 Nov;133(11):1200-5
references.pmid: 9820351
references.citation: Chest. 2006 Apr;129(4):968-78
references.pmid: 16608946
references.citation: Am J Public Health. 1994 Aug;84(8):1265-9
references.pmid: 8059883
references.citation: Chest. 1992 Jun;101(6):1644-55
references.pmid: 1303622
references.citation: Clin Infect Dis. 2003 Feb 15;36(4):396-8
references.pmid: 12567295
references.citation: Arch Intern Med. 2001 Aug 13-27;161(15):1837-42
references.pmid: 11493124
references.citation: Clin Infect Dis. 2003 Jul 15;37(2):230-7
references.pmid: 12856216
references.citation: Epidemiol Infect. 2011 Sep;139(9):1307-16
references.pmid: 20974020
references.citation: JAMA. 1996 Jan 17;275(3):194-8
references.pmid: 8604171
references.citation: Arch Intern Med. 1974 Sep;134(3):505-10
references.pmid: 4152800
references.citation: Thorax. 2004 Nov;59(11):960-5
references.pmid: 15516472
references.citation: Am J Respir Crit Care Med. 2005 Mar 1;171(5):461-8
references.pmid: 15531752