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Diabetes was the only comorbid condition associated with mortality of invasive pneumococcal infection in ICU patients: a multicenter observational study from the Outcomerea research group

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Abstract

Purposes

Streptococcus pneumoniae is a leading pathogen of severe community, hospital or nursing facility infections. We sought to describe characteristics of invasive pneumococcal infection (IPI) and pneumonia (due to the high mortality of intensive care-associated pneumonia) and to report outcomes according to various types of comorbidity.

Methods

Multicenter observational cohort study on the prospective Outcomerea database, including adult patients, with a hospital stay < 48 h before ICU admission and a documented IPI within the first 72 h of ICU admission. Comorbid conditions were defined according to the Knaus and Charlson classification.

Results

Of the 20,235 patients, 5310 (26.4%) had an invasive infection, including 560/5,310 (10.6%) who had an IPI. The ICU 28-day mortality was 109/560 (19.8%). Four factors were independently associated with mortality: SOFA day 1–2: [hazard ratio (HR) 1.21; 95% confidence interval (95% CI) 1.15–1.27, p < 0.001]; maximum lactate level day 1–2: (HR 1.07, 95% CI 1.02–1.12, p = 0.006); diabetes mellitus: (HR 1.91, 95% CI 1.23–3.03, p = 0.006) and appropriate antibiotics (HR 0.28, 95% CI 0.15–0.50, p < 0.001). Comparable results were obtained when other comorbid conditions were forced into the model. Diabetes impact was more pronounced in case of micro- or macro-angiopathy (HR 4.17, 95%CI 1.68–10.54, p = 0.003), in patients ≥ 65 years old (HR 2.59, 95% CI 1.56–4.28, < 0.001) and in those with body mass index (BMI) < 25 kg/m2 (HR 2.11, 95% CI 1.10–4.06, p = 0.025).

Conclusions

Diabetes mellitus was the only comorbid condition which independently influenced mortality in patients with IPI. Its impact was more pronounced in patients with complications, aged ≥ 65 years and with BMI < 25 kg/m2.

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Acknowledgements

We thank Celine Feger, MD (EMIBiotech), for her assistance in preparing the manuscript, and ICUREsearch SAS for the statistical analysis.

Funding

The study was granted by PfizerTM which had no role in the design, conduct or data analysis of the present study or in the decision to submit the manuscript for publication.

Author information

Authors and Affiliations

  1. UMR 1137, IAME Team 5, DeSCID: Decision Sciences in Infectious Diseases, Control and Care, Sorbonne Paris Cité, Inserm/Paris Diderot University, Paris, France

    Maité Garrouste-Orgeas & J. F. Timsit

  2. Medical Unit, French and British Institute, Levallois-Perret, France

    Maité Garrouste-Orgeas

  3. Outcomerea Research Group, Paris, France

    Maité Garrouste-Orgeas, Stéphane Ruckly & J. F. Timsit

  4. Medical Intensive Care Unit, Saint Louis University Hospital, Paris, France

    Elie Azoulay

  5. Medical Intensive Care Unit, Albert Michallon Hospital, Grenoble, France

    Carole Schwebel

  6. Medical-Surgical Intensive Care Unit, Delafontaine Hospital, Saint-Denis, France

    Etienne de Montmollin

  7. Medical Intensive Care Unit, André Mignot Hospital, Le Chesnay, France

    Jean-Pierre Bedos

  8. Medical Intensive Care Unit, Gabriel Montpied University Hospital, Clermont-Ferrand, France

    Bertrand Souweine

  9. Surgical ICU, Edouard Herriot University Hospital, Lyon, France

    Guillaume Marcotte

  10. Physiology department, Cochin University Hospital, Paris Descartes University, Paris, France

    Christophe Adrie

  11. Medical-Surgical Intensive Care Unit, Montfermeil, France

    Dany Goldgran-Toledano

  12. Medical Intensive Care Unit, Antoine Béclère Hospital, Clamart, France

    Anne-Sylvie Dumenil

  13. Medical-Surgical Unit, Andrée Rosemon Hospital, Cayenne, Guyane, France

    Hatem Kallel

  14. Medical-Surgical Unit, Sud-Essonne Hospital, Dourdan, France

    Samir Jamali

  15. Medical Intensive Care Unit, Edouard Herriot University Hospital, Lyon, France

    Laurent Argaud

  16. Medical Intensive Care Unit, Saint Etienne University Hospital, Saint-Étienne, France

    Michael Darmon

  17. Jacques Lisfranc Medicine University, Jean Monnet University, Saint-Étienne, France

    Michael Darmon

  18. Infection Control Unit, Avicenne University Hospital, Bobigny, France

    Jean-Ralph Zahar

  19. Medical and Infectious Diseases Intensive Care Unit, Bichat University Hospital, Paris Diderot University, Paris, France

    J. F. Timsit

Authors
  1. Maité Garrouste-Orgeas
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  2. Elie Azoulay
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  4. Carole Schwebel
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  5. Etienne de Montmollin
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  6. Jean-Pierre Bedos
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  7. Bertrand Souweine
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  8. Guillaume Marcotte
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  9. Christophe Adrie
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  11. Anne-Sylvie Dumenil
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  12. Hatem Kallel
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  13. Samir Jamali
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  14. Laurent Argaud
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  15. Michael Darmon
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  17. J. F. Timsit
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Contributions

MGO wrote the manuscript and MGO, EA, SR and JFT interpreted the data. All authors read the manuscript and approved the final manuscript.

Corresponding author

Correspondence to Maité Garrouste-Orgeas.

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Conflict of interest

MGO: shares in ICUREsearch. JFT: scientific board: ICUREsearch, Bayer, Merk, Paratek, 3M, Gilead. Lectures for Gilead, Pfizer, Merck, Astellas. Grants from Pfizer, 3M, Merck, Astellas. EA: is part of the board of Gilead Sciences. He has received fees for lecture from Gilead, Astellas, MSD, Alexion and Baxter. His institution has received research support from Glead, Pfizer, Fisher & Payckle, Jazz pharma, Alexion and Basilea. SR, JRZ: shares in ICUREsearch, JPB: scientific board Pfizer, Lectures Pfizer, MSD. No conflict of interests: LA, GM, CS, EdM, JPB, BS, CA, DGT, ASD, HK, SJ, MD.

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Garrouste-Orgeas, M., Azoulay, E., Ruckly, S. et al. Diabetes was the only comorbid condition associated with mortality of invasive pneumococcal infection in ICU patients: a multicenter observational study from the Outcomerea research group. Infection 46, 669–677 (2018). https://doi.org/10.1007/s15010-018-1169-6

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