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01-12-2018 | Original

Host–pathogen interactions and prognosis of critically ill immunocompetent patients with pneumococcal pneumonia: the nationwide prospective observational STREPTOGENE study

Authors: Jean-Pierre Bedos, Emmanuelle Varon, Raphael Porcher, Pierre Asfar, Yves Le Tulzo, Bruno Megarbane, Armelle Mathonnet, Anthony Dugard, Anne Veinstein, Kader Ouchenir, Shidasp Siami, Jean Reignier, Arnaud Galbois, Joël Cousson, Sébastien Preau, Olivier Baldesi, Jean-Philippe Rigaud, Bertrand Souweine, Benoit Misset, Frederic Jacobs, Florent Dewavrin, Jean-Paul Mira

Published in: Intensive Care Medicine | Issue 12/2018

Abstract

Purpose

To assess the relative importance of host and bacterial factors associated with hospital mortality in patients admitted to the intensive care unit (ICU) for pneumococcal community-acquired pneumonia (PCAP).

Methods

Immunocompetent Caucasian ICU patients with PCAP documented by cultures and/or pneumococcal urinary antigen (UAg Sp) test were included in this multicenter prospective study between 2008 and 2012. All pneumococcal strains were serotyped. Logistic regression analyses were performed to identify risk factors for hospital mortality.

Results

Of the 614 patients, 278 (45%) had septic shock, 270 (44%) had bacteremia, 307 (50%) required mechanical ventilation at admission, and 161 (26%) had a diagnosis based only on the UAg Sp test. No strains were penicillin-resistant, but 23% had decreased susceptibility. Of the 36 serotypes identified, 7 accounted for 72% of the isolates, with different distributions according to age. Although antibiotics were consistently appropriate and were started within 6 h after admission in 454 (74%) patients, 116 (18.9%) patients died. Independent predictors of hospital mortality in the adjusted analysis were platelets ≤ 100 × 10⁹/L (OR, 7.7; 95% CI, 2.8–21.1), McCabe score ≥ 2 (4.58; 1.61–13), age > 65 years (2.92; 1.49–5.74), lactates > 4 mmol/L (2.41; 1.27–4.56), male gender and septic shock (2.23; 1.30–3.83 for each), invasive mechanical ventilation (1.78; 1–3.19), and bilateral pneumonia (1.59; 1.02–2.47). Women with platelets ≤ 100 × 10⁹/L had the highest mortality risk (adjusted OR, 7.7; 2.8–21).

Conclusions

In critically ill patients with PCAP, age, gender, and organ failures at ICU admission were more strongly associated with hospital mortality than were comorbidities. Neither pneumococcal serotype nor antibiotic regimen was associated with hospital mortality.

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Title: Host–pathogen interactions and prognosis of critically ill immunocompetent patients with pneumococcal pneumonia: the nationwide prospective observational STREPTOGENE study
Authors: Jean-Pierre Bedos
Emmanuelle Varon
Raphael Porcher
Pierre Asfar
Yves Le Tulzo
Bruno Megarbane
Armelle Mathonnet
Anthony Dugard
Anne Veinstein
Kader Ouchenir
Shidasp Siami
Jean Reignier
Arnaud Galbois
Joël Cousson
Sébastien Preau
Olivier Baldesi
Jean-Philippe Rigaud
Bertrand Souweine
Benoit Misset
Frederic Jacobs
Florent Dewavrin
Jean-Paul Mira
Publication date: 01-12-2018
Publisher: Springer Berlin Heidelberg
Published in: Intensive Care Medicine / Issue 12/2018
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-018-5444-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Host–pathogen interactions and prognosis of critically ill immunocompetent patients with pneumococcal pneumonia: the nationwide prospective observational STREPTOGENE study

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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