Community-acquired pneumonia (CAP) is the leading infectious cause of death in the United States. The most common pathogen isolated from CAP patients is Streptococcus pneumoniae. Previous studies considered bacteremic pneumococcal CAP as severe CAP. The primary aim of this study was to examine if patients hospitalized with bacteremic pneumococcal (BP) CAP should be considered to have severe CAP.
A retrospective, observational study was conducted at a two tertiary teaching hospitals. Eligible patients were admitted with a diagnosis of CAP and positive blood culture for pneumococcus between 1/1/1999 and 12/31/2001. All patients had a chest x-ray consistent with CAP, and had a discharge ICD-9 diagnosis of pneumonia. Patients were excluded if they were “comfort measures only” or transferred from another acute care hospital. Patients were stratified between severe and non-severe CAP according to Pneumonia Severity Index (PSI) class V, revisited American Thoracic Society (rATS) criteria, British Thoracic Society (CURB and CURB-65 rules), or if they had severe sepsis or septic shock.
One hundred and eight patients met inclusion criteria. 71% were male, and 35% were admitted to the intensive care unit (ICU). 22% of the patients with BP-CAP were intubated and 22% received vasopressors. By severity of illness classification BP-CAP patients were PSI classes I-III in 50 (46%) of the cases, class IV in 35 (32%), and class V in 24 (22%). In addition, severe BP-CAP by CURB was defined in 44%, CURB-65 in 49%, rATS in 33%, severe sepsis 48% and septic shock in 31%, respectively. In-hospital mortality occured in 0% of the patients in PSI classes I-III, 23% in PSI IV, and in 37% in PSI V, respectively.
Bacteremic patients with pneumococcal CAP should not be considered as severe CAP, and appropriate therapy should be empirically started to improve clinical outcomes.
Further study is needed to determine whether patients with pneumococcal pneumonia could be treated differently as those with CAP.
M.I. Restrepo, None.