title: Predictive and prognostic factors in patients with blood-culture-positive community-acquired pneumococcal pneumonia.
abstract: In patients with pneumococcal community-acquired pneumonia (CAP), the risk factors for bacteraemia and its impact on outcomes are not fully elucidated. We aimed to compare characteristics of patients with blood-culture-positive versus blood-culture-negative pneumococcal CAP, and to characterise bacteraemic serotypes.We describe a prospective, observational study on nonimmunocompromised patients with pneumococcal CAP, from 1996 to 2013. We define severe pneumonia according to American Thoracic Society/Infectious Diseases Society of America guidelines.Of a total of 917 patients with pneumococcal CAP, 362 had blood-culture-positive pneumococcal pneumonia (BCPPP; 39%). High C-reactive protein (CRP) (≥20 mg·dL(-1)) (odds ratio (OR) 2.36, 95% CI 1.45-3.85), pleural effusion (OR 2.03, 95% CI 1.13-3.65) and multilobar involvement (OR 1.69, 95% CI 1.02-2.79) were independently associated with bacteraemic CAP, while nursing home resident (OR 0.12, 95% CI 0.01-1.00) was found as a protective factor. Despite the clinical differences, BCPPP showed similar outcomes to blood-culture-negative pneumococcal pneumonia (BCNPP). 14% of the serotypes (period 2006-2013) causing bacteraemia are included in pneumococcal conjugate vaccine PVC7, 74% in pneumococcal conjugate vaccine PVC13 and 83% in pneumococcal polysaccharide vaccine PPSV23.Pleural effusion, a high level of CRP and multilobar involvement predicted an increased risk of BCPPP. Although BCPPP patients were more severely ill at admission, mortality was not significantly greater than in BCNPP patients.
authors.affiliation: Dept of Pneumology, Hospital Clinic of Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Ciber de Enfermedades Respiratorias (CIBERES), Barcelona, Spain.
authors.forename: Rosanel
authors.initials: R
authors.lastname: Amaro
authors.affiliation: Respiratory Dept, Sotiria Chest Diseases Hospital, Athens, Greece.
authors.forename: Adamantia
authors.initials: A
authors.lastname: Liapikou
authors.affiliation: Dept of Pneumology, Hospital Clinic of Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Ciber de Enfermedades Respiratorias (CIBERES), Barcelona, Spain.
authors.forename: Catia
authors.initials: C
authors.lastname: Cilloniz
authors.affiliation: Dept of Pneumology, Hospital Clinic of Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Ciber de Enfermedades Respiratorias (CIBERES), Barcelona, Spain.
authors.forename: Albert
authors.initials: A
authors.lastname: Gabarrus
authors.affiliation: Dept of Microbiology, Centre Diagnostic Biomèdic (CDB), Hospital Clinic of Barcelona, Barcelona, Spain Barcelona Institute for Global Health, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain.
authors.forename: Francesc
authors.initials: F
authors.lastname: Marco
authors.affiliation: Dept of Pneumology, Hospital Clinic of Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Ciber de Enfermedades Respiratorias (CIBERES), Barcelona, Spain.
authors.forename: Jacobo
authors.initials: J
authors.lastname: Sellares
authors.affiliation: Dept of Pneumology, Hospital Clinic of Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Ciber de Enfermedades Respiratorias (CIBERES), Barcelona, Spain.
authors.forename: Eva
authors.initials: E
authors.lastname: Polverino
authors.affiliation: Dept of Medicine, Hospital Universitari Mutua de Terrassa, Terrassa, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Garau
authors.affiliation: Dept of Pneumology, Hospital Clinic of Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Ciber de Enfermedades Respiratorias (CIBERES), Barcelona, Spain.
authors.forename: Miquel
authors.initials: M
authors.lastname: Ferrer
authors.affiliation: Dept of Medicine, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Musher
authors.affiliation: Dept of Pneumology, Hospital Clinic of Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Ciber de Enfermedades Respiratorias (CIBERES), Barcelona, Spain atorres@ub.edu.
authors.forename: Antoni
authors.initials: A
authors.lastname: Torres
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000150:complications; D002097:C-Reactive Protein / Q000032:analysis; D017714:Community-Acquired Infections / Q000097:blood* / Q000175:diagnosis*; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009735:Nursing Homes; D016017:Odds Ratio; D022242:Pneumococcal Vaccines / Q000627:therapeutic use; D011018:Pneumonia, Pneumococcal / Q000097:blood* / Q000175:diagnosis*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D013296:Streptococcus pneumoniae; D016896:Treatment Outcome
chemical_list: D022242:Pneumococcal Vaccines; D002097:C-Reactive Protein