Rate of 30-day mortality per period.

<p>Rate of 30-day mortality per period.</p

Twenty-year trend in mortality among hospitalized patients with pneumococcal community-acquired pneumonia

<div><p>Background</p><p>There is only limited information on mortality over extended periods in hospitalized patients with pneumococcal community-acquired pneumonia (CAP). We aimed to evaluate the 30-day mortality and whether is changed over a 20-year period among immunocompetent adults hospitalized with pneumococcal CAP.</p><p>Methods</p><p>We conducted a retrospective observational study of data that were prospectively collected at the Hospital Clinic of Barcelona of all adult patients hospitalized with diagnosis of pneumococcal CAP over a 20-year period. To aid analysis, results were divided into four periods of 5 years each (1997–2001, 2002–2006, 2007–2011, 2012–2016). The primary outcome was 30-day mortality, but secondary outcomes included intensive care unit (ICU) admission, lengths of hospital and ICU-stays, ICU-mortality, and need of mechanical ventilation.</p><p>Results</p><p>From a cohort of 6,403 patients with CAP, we analyzed the data for 1,120 (17%) adults with a diagnosis of pneumococcal CAP. Over time, we observed decreases in the rates of alcohol consumption, smoking, influenza vaccination, and older patients (age ≥65 years), but increases in admissions to ICU and the need for non-invasive mechanical ventilation. The overall 30-day mortality rate was 8% (95% confidence interval, 6%–9%; 84 of 1,120 patients) and did not change significantly between periods (p = 0.33). Although, we observed a decrease in ICU-mortality comparing the first period (26%) to the second one (10%), statistical differences disappeared with adjustment (p0.38).</p><p>Conclusion</p><p>Over time, 30-day mortality of hospitalized pneumococcal CAP did not change significantly. Nor did it change in the propensity-adjusted multivariable analysis. Since mortality in pneumococcal pneumonia has remained unaltered for many years despite the availability of antimicrobial agents with proven in vitro activity, other non-antibiotic strategies should be investigated.</p></div

Patients’ characteristics by study period.

<p>Patients’ characteristics by study period.</p

Samples for microbiological diagnosis of pneumococcal pneumonia by study period.

<p>Samples for microbiological diagnosis of pneumococcal pneumonia by study period.</p

Flow chart of study population.

<p>Flow chart of study population.</p

Significant univariable and multivariable Cox regression analyses for the prediction of 30-day mortality.

<p>Significant univariable and multivariable Cox regression analyses for the prediction of 30-day mortality.</p

Significant univariable and multivariable cox regression analyses for the prediction of icu mortality.

<p>Significant univariable and multivariable cox regression analyses for the prediction of icu mortality.</p

Outcomes by study period.

<p>Outcomes by study period.</p

Kaplan-Meier analysis on the effect of period on time to death.

<p>Kaplan-Meier analysis on the effect of period on time to death.</p

Time to blood culture positivity as a predictor of clinical outcomes and severity in adults with bacteremic pneumococcal pneumonia

<div><p>Objectives</p><p>We aimed to investigate the association between the time to positivity of blood culture (TTP) with clinical outcome and severity of pneumococcal bacteremic pneumonia.</p><p>Methods</p><p>Prospective observational study carried out in 278 hospitalized adult CAP patients with positive blood culture for <i>Streptococcus pneumonia</i> (2003–2015).</p><p>Results</p><p>A total of 278 cases of bacteremic pneumococcal pneumonia were analyzed, median age 62 (46; 79) years. Fifty-one percent of the cases had PSI IV-V. Twenty-one (8%) died within 30-days after admission. The analysis of the TTP showed that the first quartile of the TTP (9.2h) was the best cut-off for differentiating 2 groups of patients at risk, early (TTP <9.2 h) and late (TTP ≥9.2 h) detection groups (AUC 0.66 [95% CI 0.53 to 0.79]). Early TTP was associated with a statistically significant risk of invasive mechanical ventilation (18% vs. 6%, p = 0.007), longer length of hospital stay (12 days vs. 8 days, p<0.001), higher in-hospital mortality (15% vs. 4%, p = 0.010), and 30-day mortality (15% vs. 5%, p = 0.018). After adjustment for potential confounders, regression analyses revealed early TTP as independently associated with high risk of invasive mechanical ventilation (OR 4.60, 95% CI 1.63 to 13.03), longer length of hospital stay (β 5.20, 95% CI 1.81 to 8.52), higher in-hospital mortality (OR 5.35, 95% CI 1.55 to 18.53), and a trend to higher 30-day mortality (OR 2.47, 95% CI 0.85 to 7.21) to be a contributing factor.</p><p>Conclusion</p><p>Our results demonstrate that TTP is an easy to obtain surrogate marker of the severity of pneumococcal pneumonia and a good predictor of its outcome.</p></div