0
Original Research: COMMUNITY-ACQUIRED PNEUMONIA |

Severity of Pneumococcal Pneumonia Associated With Genomic Bacterial Load

Jordi Rello, MD, PhD; Thiago Lisboa, MD; Manel Lujan, MD; Miguel Gallego, MD; Cordelia Kee, PhD; Ian Kay, BSc, MBSc; Diego Lopez, MD; Grant W. Waterer, MBBS, PhD, FCCP; for the DNA-Neumococo Study Group
Author and Funding Information

Affiliations: From the Critical Care Department (Drs. Rello and Lisboa), Hospital Universitari Joan XXIII, Tarragona, Spain; University Rovira i Virgili (Drs. Rello and Lisboa), IISPV, Tarragona, Spain; Centro de Investigacíon Biomedica en Red Enfermedades Respiratorias (CIBERes) [Drs. Rello, Lisboa, Lujan, Gallego, and Lopez], Tarragona, Spain; Hospital de Sabadell (Drs. Lujan and Gallego), Sabadell, Spain; School of Medicine and Pharmacology (Drs. Kee and Waterer), University of Western Australia, Perth, WA, Australia; the Department of Microbiology and Infectious Diseases (Mr. Kay), Royal Perth Hospital, Perth, WA, Australia; and Fundación Jimenez Diaz (Dr. Lopez), Madrid, Spain.

Correspondence to: Jordi Rello, MD, PhD, Critical Care Department, Joan XXIII University Hospital, Carrer Dr. Mallafre Guasch 4, 43007 Tarragona, Spain; e-mail: jrello.hj23.ics@gencat.cat

*A complete list of members of the DNA-Neumococo Study Group is located in the Appendix.


Presented in part at the 2008 American Thoracic Society Conference, Toronto, ON, Canada.

This study was funded by FIS 04/1500, Fondo de Investigaciones Sanitarias, CIBER Enfermedades Respiratorias (CIBERes 06/06/0036), and AGAUR (2005/SGR/920). Dr. Waterer is supported by the National Health and Medical Research Council of Australia.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.xhtml).


© 2009 American College of Chest Physicians


Chest. 2009;136(3):832-840. doi:10.1378/chest.09-0258
Text Size: A A A
Published online

Background:  There is a clinical need for more objective methods of identifying patients at risk for septic shock and poorer outcomes among those with community-acquired pneumonia (CAP). As viral load is useful in viral infections, we hypothesized that bacterial load may be associated with outcomes in patients with pneumococcal pneumonia.

Methods:  Quantification of Streptococcus pneumoniae DNA level by real-time polymerase chain reaction (rt-PCR) was prospectively conducted on whole-blood samples from a cohort of 353 patients who were displaying CAP symptoms upon their admission to the ED.

Results:  CAP caused by S pneumoniae was documented in 93 patients (36.5% with positive blood culture findings). A positive S pneumoniae rt-PCR assay finding was associated with a statistically significant higher mortality (odds ratio [OR], 7.08), risk for shock (OR, 6.29), and the need for mechanical ventilation (MV) [OR, 7.96]. Logistic regression, adjusted for age, sex, comorbidities, and pneumonia severity index class, revealed bacterial load as independently associated with septic shock (adjusted odds ratio [aOR], 2.42; 95% CI, 1.10 to 5.80) and the need for MV (aOR, 2.71; 95% CI, 1.17 to 6.27). An S pneumoniae bacterial load of ≥ 103 copies per milliliter occurred in 29.0% of patients (27 of 93 patients; 95% CI, 20.8 to 38.9%) being associated with a statistically significant higher risk for septic shock (OR, 8.00), the need for MV (OR, 10.50), and hospital mortality (OR, 5.43).

Conclusion:  In patients with pneumococcal pneumonia, bacterial load is associated with the likelihood of death, the risk of septic shock, and the need for MV. High genomic bacterial load for S pneumoniae may be a useful tool for severity assessment.

Figures in this Article

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543