Abstract
The diagnosis of invasive pneumococcal pneumonia is based mainly on bacteraemia. Episodes without bacteraemia, but with a positive urinary antigen test (UAT), are considered non-invasive. We determined differences in outcome between patients with bacteraemic and non-bacteraemic/UAT-positive pneumococcal community-acquired pneumonia (CAP). Adult patients with clinical and radiological evidence of CAP with blood cultures and UAT tests performed at presentation in three Dutch laboratories between June 2008 and May 2010 were included. Clinical characteristics were retrospectively extracted from hospital records. Overall, 168 patients had non-bacteraemic/UAT-positive pneumococcal CAP and 123 had bacteraemic pneumococcal CAP. The day-30 mortality was 9 % and 13 % for non-bacteraemic/UAT-positive and bacteraemic pneumococcal CAP patients, respectively [risk difference −4 %, 95 % confidence interval (CI) −11 % to +3 %, p = 0.28]. In a multivariable logistic regression model, age ≥65 years, admission to the intensive care unit/coronary care unit (ICU/CCU) and presence of an immunocompromising condition were associated with day-30 mortality. A non-significant association with mortality was found for bacteraemia [odds ratio (OR) 2.21, 95 % CI 0.94–5.21, p = 0.07). No such trend was found for UAT positivity. The median lengths of hospital stay were 8 [interquartile range (IQR) 5–14] and 10 (IQR 6–18) days for non-bacteraemic/UAT-positive and bacteraemic pneumococcal CAP patients, respectively (p = 0.05). As compared to non-bacteraemic/UAT-positive pneumococcal CAP, bacteraemic pneumococcal CAP has a stronger association with day-30 mortality.
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Acknowledgements
We would like to thank the medical students, participating laboratories and hospitals for making the data collection possible.
Funding
This study was supported, in part, by an unrestricted research grant from Pfizer Pharmaceuticals. The sponsor played no role in the study design, data analyses, and preparation, review or approval of the manuscript.
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The authors declare that they have no conflict of interest with regard to the submitted work.
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van Mens, S.P., van Deursen, A.M.M., de Greeff, S.C. et al. Bacteraemic and non-bacteraemic/urinary antigen-positive pneumococcal community-acquired pneumonia compared. Eur J Clin Microbiol Infect Dis 34, 115–122 (2015). https://doi.org/10.1007/s10096-014-2209-5
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DOI: https://doi.org/10.1007/s10096-014-2209-5