Prognostic factors of Streptococcus pneumoniae infection in adults.
OBJECTIVE
The mortality of severe sepsis has markedly decreased since the implementation of the Surviving Sepsis Campaign guidelines. The next logical step is to examine the necessity of individualized management guidelines for targeted therapy against specific bacteria. Streptococcus pneumoniae is the leading cause of community-acquired severe sepsis; however, little is known regarding the prognostic factors in adult patients with S pneumoniae sepsis. We aimed to identify prognostic factors in patients with S pneumoniae sepsis and to explore a subgroup of patients at high risk for death with detailed Sequential Organ Failure Assessment (SOFA) score analysis.


METHODS
We retrospectively reviewed the records of patients with S pneumoniae infection treated between 1st January 2006 and 31st July 2012. We identified prognostic factors for 28-day mortality using univariate and multivariate logistic regression models.


RESULTS
Of 171 patients (median age, 72 years) with S pneumoniae infection who were included in this study, the 28-day mortality was 17% (29/171). The SOFA score (odds ratio, 2.25; 95% confidence interval, 1.60-3.18; P < .001) and bacteremia (odds ratio, 19.0; 95% confidence interval, 4.06-90.20; P < .001) were identified as prognostic factors for the 28-day mortality. In a subgroup analysis with a cutoff value of the SOFA score determined by receiver operating characteristic analysis, patients with bacteremia and a SOFA score of at least 7 had a significantly higher mortality than did patients without bacteremia and a SOFA score lower than 7 (84% vs 0%, respectively).


CONCLUSIONS
Bacteremia and a SOFA score at least 7 were independent prognostic factors of poor outcome in S pneumoniae sepsis.
Emergency Medical Center, Kagawa University Hospital, Miki, Kita, Kagawa, Japan. Electronic address: hifumitoru@gmail.com.
Toru
T
Hifumi
Center for General Internal Medicine and Education, Keio University Hospital, Shinjuku-ku, Tokyo, Japan.
Seitaro
S
Fujishima
Center for Clinical Research, Department of Preventive Medicine and Public Health, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan.
Takayuki
T
Abe
Division of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, Tachikawa, Tokyo, Japan.
Nobuaki
N
Kiriu
Division of Critical Care Medicine and Trauma, Yamanashi Prefectural Central Hospital, Kofu, Yamanashi, Japan.
Junichi
J
Inoue
Division of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, Tachikawa, Tokyo, Japan.
Hiroshi
H
Kato
Division of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, Tachikawa, Tokyo, Japan.
Yuichi
Y
Koido
Emergency Medical Center, Kagawa University Hospital, Miki, Kita, Kagawa, Japan.
Kenya
K
Kawakita
Emergency Medical Center, Kagawa University Hospital, Miki, Kita, Kagawa, Japan.
Yasuhiro
Y
Kuroda
Department of Emergency Medicine and Critical Care Medicine, Keio University Hospital, Shinjuku-ku, Tokyo, Japan.
Junichi
J
Sasaki
Department of Emergency Medicine and Critical Care Medicine, Keio University Hospital, Shinjuku-ku, Tokyo, Japan.
Shingo
S
Hori
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000382:microbiology / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000401:mortality; D063305:Organ Dysfunction Scores; D011008:Pneumococcal Infections / Q000401:mortality*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors