Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

ACC 2024 Congress

Catch up on all the top stories and latest evidence in cardiology research with our ACC 2024 Congress hub page.
ADVANCED SEARCH
Log in
Top
BMC Pulmonary Medicine
Published in: BMC Pulmonary Medicine 1/2018

Open Access 01-12-2018 | Research article

A model for predicting bacteremia in patients with community-acquired pneumococcal pneumonia: a retrospective observational study

Authors: Yasuyoshi Washio, Akihiro Ito, Shogo Kumagai, Tadashi Ishida, Akio Yamazaki

Published in: BMC Pulmonary Medicine | Issue 1/2018

Login to get access

Abstract

Background

Pneumococcal pneumonia causes high morbidity and mortality among adults. This study aimed to identify risk factors for bacteremic pneumococcal pneumonia, and to construct a prediction model for the development of bacteremia in patients with community-acquired pneumococcal pneumonia.

Methods

We retrospectively analyzed data from patients hospitalized with community-acquired pneumococcal pneumonia between April 2007 and August 2015. Logistic regression models were applied to detect risk factors for pneumococcal bacteremia, and a receiver operating characteristic curve was used to devise a prediction model.

Results

Based on the results of sputum cultures, urine antigen tests, and/or blood cultures, 389 patients were diagnosed with pneumococcal pneumonia, 46 of whom had bacteremia. In the multivariate analysis, age < 65 years, serum albumin level < 3.0 g/dL, need for intensive respiratory or vasopressor support (IRVS), and C-reactive protein level > 20 mg/dL were identified as independent risk factors for the development of pneumococcal bacteremia. The bacteremia prediction score based on receiver operating characteristic curve analysis had a sensitivity of 0.74 and a specificity of 0.78 in patients with two risk factors. The area under the receiver operating characteristic curve was 0.77 (95% confidence interval (CI), 0.70–0.85).

Conclusions

Age < 65 years, hypoalbuminemia, IRVS, and high C-reactive protein level on admission are independent risk factors for the development of bacteremia in patients with community-acquired pneumococcal pneumonia. A prediction model based on these four risk factors could help to identify patients with community-acquired pneumococcal pneumonia at high risk of developing bacteremia; this can be used to guide antibiotic choices.

Trial registration

UMIN-CTR UMIN 000004353. Registered 7 October 2010. Retrospectively registered.
Literature
1.
Ardanuy C, Tubau F, Pallares R, Calatayud L, Dominguez MA, Rolo D, et al. Epidemiology of invasive pneumococcal disease among adult patients in barcelona before and after pediatric 7-valent pneumococcal conjugate vaccine introduction, 1997-2007. Clin Infect Dis. 2009;48:57–64.CrossRefPubMed
2.
Roson B, Carratala J, Dorca J, Casanova A, Manresa F, Gudiol F. Etiology, reasons for hospitalization, risk classes, and outcomes of community-acquired pneumonia in patients hospitalized on the basis of conventional admission criteria. Clin Infect Dis. 2001;33:158–65.CrossRefPubMed
3.
Shariatzadeh MR, Huang JQ, Tyrrell GJ, Johnson MM, Marrie TJ. Bacteremic pneumococcal pneumonia: a prospective study in Edmonton and neighboring municipalities. Medicine (Baltimore). 2005;84:147–61.CrossRef
4.
Bartlett JG. Diagnostic tests for agents of community-acquired pneumonia. Clin Infect Dis. 2011;52(Suppl 4):S296–304.CrossRefPubMed
5.
van der Eerden MM, Vlaspolder F, de Graaff CS, Groot T, Bronsveld W, Jansen HM, et al. Comparison between pathogen directed antibiotic treatment and empirical broad spectrum antibiotic treatment in patients with community acquired pneumonia: a prospective randomised study. Thorax. 2005;60:672–8.CrossRefPubMedPubMedCentral
6.
Taniguchi T, Tsuha S, Shiiki S, Narita M. Gram-stain-based antimicrobial selection reduces cost and overuse compared with Japanese guidelines. BMC Infect Dis. 2015;15:458.CrossRefPubMedPubMedCentral
7.
Skerrett SJ. Diagnostic testing to establish a microbial cause is helpful in the management of community-acquired pneumonia. Semin Respir Infect. 1997;12:308–21.PubMed
8.
Luna CM, Famiglietti A, Absi R, Videla AJ, Nogueira FJ, Fuenzalida AD, et al. Community-acquired pneumonia: etiology, epidemiology, and outcome at a teaching hospital in Argentina. Chest. 2000;118:1344–54.CrossRefPubMed
9.
Garcia-Vidal C, Ardanuy C, Tubau F, Viasus D, Dorca J, Linares J, et al. Pneumococcal pneumonia presenting with septic shock: host- and pathogen-related factors and outcomes. Thorax. 2010;65:77–81.CrossRefPubMed
10.
Capelastegui A, Zalacain R, Bilbao A, Egurrola M, Iturriaga LA, Quintana JM, et al. Pneumococcal pneumonia: differences according to blood culture results. BMC Pulm Med. 2014;14:128.CrossRefPubMedPubMedCentral
11.
Metersky ML, Ma A, Bratzler DW, Houck PM. Predicting bacteremia in patients with community-acquired pneumonia. Am J Respir Crit Care Med. 2004;169:342–7.CrossRefPubMed
12.
Kang CI, Song JH, Kim SH, Chung DR, Peck KR, Thamlikitkul V, et al. Risk factors and pathogenic significance of bacteremic pneumonia in adult patients with community-acquired pneumococcal pneumonia. J Inf Secur. 2013;66:34–40.
13.
Martinez JA, Horcajada JP, Almela M, Marco F, Soriano A, Garcia E, et al. Addition of a macrolide to a beta-lactam-based empirical antibiotic regimen is associated with lower in-hospital mortality for patients with bacteremic pneumococcal pneumonia. Clin Infect Dis. 2003;36:389–95.CrossRefPubMed
14.
Falguera M, Trujillano J, Caro S, Menendez R, Carratala J, Ruiz-Gonzalez A, et al. A prediction rule for estimating the risk of bacteremia in patients with community-acquired pneumonia. Clin Infect Dis. 2009;49:409–16.CrossRefPubMed
15.
Lee J, Hwang SS, Kim K, Jo YH, Lee JH, Kim J, et al. Bacteremia prediction model using a common clinical test in patients with community-acquired pneumonia. Am J Emerg Med. 2014;32:700–4.CrossRefPubMed
16.
Fine MJ, Auble TE, Yealy DM, Hanusa BH, Weissfeld LA, Singer DE, et al. A prediction rule to identify low-risk patients with community-acquired pneumonia. New Engl J Med. 1997;336:243–50.CrossRefPubMed
17.
Lim WS, van der Eerden MM, Laing R, Boersma WG, Karalus N, Town GI, et al. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax. 2003;58:377–82.CrossRefPubMedPubMedCentral
18.
Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007;44(Suppl 2):S27–72.CrossRefPubMed
19.
Charles PG, Wolfe R, Whitby M, Fine MJ, Fuller AJ, Stirling R, et al. SMART-COP: a tool for predicting the need for intensive respiratory or vasopressor support in community-acquired pneumonia. Clin Infect Dis. 2008;47:375–84.CrossRefPubMed
20.
Jover F, Cuadrado JM, Andreu L, Martinez S, Canizares R, de la Tabla VO, et al. A comparative study of bacteremic and non-bacteremic pneumococcal pneumonia. Eur. J Int Med. 2008;19:15–21.
21.
Amaro R, Liapikou A, Cilloniz C, Gabarrus A, Marco F, Sellares J, et al. Predictive and prognostic factors in patients with blood-culture-positive community-acquired pneumococcal pneumonia. Eur Respir J. 2016;48:797–807.CrossRefPubMed
22.
Kalin M, Ortqvist A, Almela M, Aufwerber E, Dwyer R, Henriques B, et al. Prospective study of prognostic factors in community-acquired bacteremic pneumococcal disease in 5 countries. J Infect Dis. 2000;182:840–7.CrossRefPubMed
23.
Plouffe JF, Breiman RF, Facklam RR. Bacteremia with Streptococcus Pneumoniae. Implications for therapy and prevention. Franklin County pneumonia study group. JAMA. 1996;275:194–8.CrossRefPubMed
24.
Marrie TJ, Low DE, De Carolis E, Canadian community-acquired pneumonia I. A comparison of bacteremic pneumococcal pneumonia with nonbacteremic community-acquired pneumonia of any etiology--results from a Canadian multicentre study. Can Respir J. 2003;10(7):368–74.CrossRefPubMed
25.
Tomczyk S, Bennett NM, Stoecker C, Gierke R, Moore MR, Whitney CG, et al. Use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine among adults aged ≥65 years: recommendations of the advisory committee on immunization practices (ACIP). MMWR Morb Mortal Wkly Rep. 2014;63:822–5.PubMed
26.
Musher DM, Rueda-Jaimes AM, Graviss EA, Rodriguez-Barradas MC. Effect of pneumococcal vaccination: a comparison of vaccination rates in patients with bacteremic and nonbacteremic pneumococcal pneumonia. Clin Infect Dis. 2006;43:1004–8.CrossRefPubMed
27.
28.
Ritchie ND, Mitchell TJ, Evans TJ. What is different about serotype 1 pneumococci? Future Microbiol. 2012;7:33–46.CrossRefPubMed
29.
Ceccato A, Torres A, Cilloniz C, Amaro R, Gabarrus A, Polverino E, et al. Invasive disease vs urinary antigen-confirmed pneumococcal community-acquired pneumonia. Chest. 2017;151:1311–9.CrossRefPubMed
30.
Goldwasser P, Feldman J. Association of serum albumin and mortality risk. J Clin Epidemiol. 1997;50:693–703.CrossRefPubMed
31.
Ranzani OT, Zampieri FG, Forte DN, Azevedo LC, Park M. C-reactive protein/albumin ratio predicts 90-day mortality of septic patients. PLoS One. 2013;8(3):e59321.CrossRefPubMedPubMedCentral
32.
Musher DM, Rueda AM, Kaka AS, Mapara SM. The association between pneumococcal pneumonia and acute cardiac events. Clin Infect Dis. 2007;45:158–65.CrossRefPubMed
33.
Horton JW, Maass DL, White J, Sanders B. Myocardial inflammatory responses to sepsis complicated by previous burn injury. Surg Infect. 2003;4:363–77.CrossRef
34.
Fillon S, Soulis K, Rajasekaran S, Benedict-Hamilton H, Radin JN, Orihuela CJ, et al. Platelet-activating factor receptor and innate immunity: uptake of gram-positive bacterial cell wall into host cells and cell-specific pathophysiology. J Immunol. 2006;177:6182–91.CrossRefPubMed
35.
Reyes LF, Restrepo MI, Hinojosa CA, Soni NJ, Anzueto A, Babu BL, et al. Severe pneumococcal pneumonia causes acute cardiac toxicity and subsequent cardiac remodeling. Am J Respir Crit Care Med. 2017;196:609–20.CrossRefPubMed
36.
Postma DF, van Werkhoven CH, van Elden LJ, Thijsen SF, Hoepelman AI, Kluytmans JA, et al. Antibiotic treatment strategies for community-acquired pneumonia in adults. New Engl J Med. 2015;372:1312–23.CrossRefPubMed
37.
Baddour LM, Yu VL, Klugman KP, Feldman C, Ortqvist A, Rello J, et al. Combination antibiotic therapy lowers mortality among severely ill patients with pneumococcal bacteremia. Am J Respir Crit Care Med. 2004;170:440–4.CrossRefPubMed
Metadata
Title
A model for predicting bacteremia in patients with community-acquired pneumococcal pneumonia: a retrospective observational study
Authors
Yasuyoshi Washio
Akihiro Ito
Shogo Kumagai
Tadashi Ishida
Akio Yamazaki
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Pulmonary Medicine / Issue 1/2018
Electronic ISSN: 1471-2466
DOI
https://doi.org/10.1186/s12890-018-0572-1

Other articles of this Issue 1/2018

BMC Pulmonary Medicine 1/2018 Go to the issue

Research article

Six underlying health conditions strongly influence mortality based on pneumonia severity in an ageing population of Japan: a prospective cohort study

Research article

Acute effects of combined exercise and oscillatory positive expiratory pressure therapy on sputum properties and lung diffusing capacity in cystic fibrosis: a randomized, controlled, crossover trial

Case report

Miliary tuberculosis with co-existing pulmonary cryptococcosis in non-HIV patient without underlying diseases: a case report

Research article

NonTuberculous Mycobacteria infection and lung transplantation in cystic fibrosis: a worldwide survey of clinical practice

Review

Geographic variation in the aetiology, epidemiology and microbiology of bronchiectasis

Research article

The long-term rate of change in lung function in urban professional firefighters: a systematic review

ACC 2024 Congress Coverage

Cardiology Video

Highlights from the ACC 2024 Congress

Watch now

Watch official videos from the ACC congress summarizing key highlights from the last year in heart failure, cardiomyopathies, valvular disease, pulmonary vascular disease, and pediatric cardiology.

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits