1223. Bacteremic Pneumococcal Pneumonia: a Prospective, 15-Year Single-Center Study in 246 Adult Patients
Session: Poster Abstract Session: Pneumococcal Epidemiology
Saturday, October 22, 2011
Room: Poster Hall B1
Background:

  Bacteremic pneumonia  remains a major cause of morbidity and mortality despite improvements in medical care.Objectives: to describe  features of bacteremic pneumococcal pneumonia (BPP) in our environment; and  to assess risk factors for mortality.

Methods:

Adults with BPP admitted to Santamarina Hospital, a 120-bed community hospital, were prospectively studied from January 1996 through January 2011. Demographics, underlying medical conditions, disease severity, clinical outcomes and radiologic patterns were assessed. Microbiological studies were performed according to CLSI. Data were analysed using SAS 9.1.3 software

Results:

A total of 246 patients were evaluated. The incidence of BPP was 2.1 cases per 1000 admissions, 159 were men, mean age was 59.3 years (18-97). Mean time from onset of symptoms to admission was 2.9 days (1-15). Fever, cough, dyspnea and chest pain were the most common presenting symptoms, half of the patients had non-respiratory manifestations.

According to the pneumonia severity index, 78% of patients were low risk (class I-III). Cigarette smoking, chronic obstructive lung disease, congestive heart failure and alcoholism were the most common underlying conditions.

Complications: 20% of patients were admitted to ICU, 16% required mechanical ventilation 8% developed empyema. The 30-day mortality rate was 16.7% (41 patients), 56% of deaths occurred within 3 days of admission.

Chest radiography: a lobar pattern predominated in survivors and a diffuse pattern in non-survivors (p=0.0021). Pleural effusion was found in 17%.

Only 4 S pneumoniae strains were non susceptible to penicillin. 

In the multivariate analysis factors associated with mortality were: dyspnea OR: 6.15 (95% CI 2.07-18.69), age > 80 years 5.89 (1.99-17.04), confusion 3.66 (1-39-9.66), and hypotension 2.55 (1.01-6.46); fever and chest pain were associated with good outcome 0.171 (0.069-0.420) and 0.294 (0.101-0.856) respectively

Conclusion: 

 The incidence of BPP in our hospital has remained constant over the 15-year study period. Dyspnea, hypotension, confusion and age > 80 years were associated with mortality, whereas fever and chest pain were associated with good outcome. Most deaths occurred early


Subject Category: C. Clinical studies of bacterial infections and antibacterials including sexually transmitted diseases and mycobacterial infections (surveys, epidemiology, and clinical trials)

Jorge Héctor Gentile, MD, Infectious diseases, Hospital Santamarina, Tandil, Argentina, Mónica delfina Sparo, bacteriologist, Bacteriology, Hospital Santamarina, Tandil, Argentina, Claudia Isabel Hernández, Phy, Infectious Diseases, Hospital Santamarina, Tandil, Argentina and Edgardo Rodriguez, Veterinarian, Statistic, Universidad Nacional del Centro, Tandil, Argentina

Disclosures:

J. H. Gentile, None

M. D. Sparo, None

C. I. Hernández, None

E. Rodriguez, None

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