PURPOSE: Community-acquired pneumonia leads to 1.7 million hospital admissions in the United States and is the most common cause of death from infection. Streptococcus pneumonia is an important and well-known cause of bacteremia in both immunocompetent and immunosuppressed patients with pneumonia. The CURB-65 score is an algorithm based upon five easily measurable factors from which its name is derived (Confusion, Urea >20mg/dl, Respiratory rate >30, Blood pressure systolic <90 and diastolic <60 and Age >65). The aim of the study was to assess the utility of CURB-65 score in predicting the need of ICU admission and mechanical ventilation.
METHODS: We conducted a retrospective observational study between January 2006 and February 2007 in our tertiary care facility, in patients with bacteremic pneumococcal pneumonia. Data collection included: CURB-65 score, risk factors for bacteremia, antibiotics used, the need for ICU admission, mechanical ventilation and 28 day mortality. Relationships were examined using Chi-Square statistic with p < 0.05 as significant. This study was approved by our University Institutional Review Board.
RESULTS: Forty-five patients were studied. They had a mean age of 56 years; 20 were males. The mean CURB-65 score on admission was 1.6(range 0-4) Nine patients required mechanical ventilation. There was no statistically significant relationship between CURB-65 and mechanical ventilation. 14 patients needed ICU admission with an Odds ratio of 3.1 favoring patients with higher CURB-65 score. Antibiotic therapy was started with ceftriaxone/azithromycin in 21/45=46% of patients. Risk factors for bacteremia included HIV in 14 patients, malignancies 5, COPD 8, CHF 5, liver disease 11, diabetes 10, alcohol abuse 7 and renal failure in 3 patients. Mortality occurred in 5/45 = 11% of patients.
CONCLUSION: CURB-65 failed to predict the need for mechanical ventilation in patients with bacteremic pneumococcal pneumonia.
CLINICAL IMPLICATIONS: CURB-65 remains a desirable guide for predicting the need for hospital admission and ICU care but should not be used for predicting the need for mechanical ventilation.
DISCLOSURE: Ghulam Khaleeq, None.