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24-08-2014 | Infectious disease | Article

Bacteremia linked to worse in-hospital course, outcomes in patients with pneumonia

Abstract

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medwireNews: The presence of bacteremia in patients with pneumonia is associated with a worse in-hospital course of illness and poorer patient outcomes, show Spanish findings.

This is despite illness severity being similar on admission to patients without bacteraemia, say Alberto Capelastegui (Hospital de Galdakao-Usansolo, Bizkaia, Spain) and co-authors.

Writing in BMC Pulmonary Medicine, the researchers explain that case-fatality rates among adults with bacteraemic pneumococcal pneumonia have improved little in the past 3 decades and, in general, remain high. This is despite the introduction of the pneumococcal vaccination.

The team compared the clinical outcomes of pneumonia patients with (n=399) and without (n=492) positive blood culture results to assess whether bacteremia was related to severity on admission, septic shock at admission or during hospitalisation, and mortality.

All patients were admitted to hospital with pneumonia between January 2001 and July 2009.

On admission, the severity of illness, as measured by the CURB-65 (Confusion, Urea nitrogen, Respiratory rate, Blood pressure, age ≥65 years) score, was similar in both groups

Patients with pneumococcal bacteremia had significantly higher need for mechanical ventilation use, septic shock and treatment failure during hospitalisation, and higher rates of in-hospital, 15-day and 30-day mortality, as well as longer hospital stays.

After adjusting for severity of illness at admission, the researchers found that patients with pneumococcal bacteremia were 2.1 times more likely to develop septic shock than those without.

In-hospital mortality rates were also 2.1 times greater for patients with a positive blood culture than for those without. And 15- and 30-day mortality rates were 3.6 and 2.7 times higher in these patients, respectively.

“Our findings indicate that the bacteremic patients had a poorer prognosis and higher case-fatality rate, while the illness severity on admission was similar in the two groups as assessed by the CURB-65 score,” say Capelastegui et al. “It is possible that bacteremic pneumococcal pneumonia adds some features that are not captured by this severity score.”

They conclude: “Bacteremia in pneumococcal pneumonia has prognostic significance given that it is associated with poorer outcomes.”

medwireNews (www.medwirenews.com) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2014

By Nikki Withers, medwireNews Reporter

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