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Host–pathogen interactions and prognosis of critically ill immunocompetent patients with pneumococcal pneumonia: the nationwide prospective observational STREPTOGENE study

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Abstract

Purpose

To assess the relative importance of host and bacterial factors associated with hospital mortality in patients admitted to the intensive care unit (ICU) for pneumococcal community-acquired pneumonia (PCAP).

Methods

Immunocompetent Caucasian ICU patients with PCAP documented by cultures and/or pneumococcal urinary antigen (UAg Sp) test were included in this multicenter prospective study between 2008 and 2012. All pneumococcal strains were serotyped. Logistic regression analyses were performed to identify risk factors for hospital mortality.

Results

Of the 614 patients, 278 (45%) had septic shock, 270 (44%) had bacteremia, 307 (50%) required mechanical ventilation at admission, and 161 (26%) had a diagnosis based only on the UAg Sp test. No strains were penicillin-resistant, but 23% had decreased susceptibility. Of the 36 serotypes identified, 7 accounted for 72% of the isolates, with different distributions according to age. Although antibiotics were consistently appropriate and were started within 6 h after admission in 454 (74%) patients, 116 (18.9%) patients died. Independent predictors of hospital mortality in the adjusted analysis were platelets ≤ 100 × 109/L (OR, 7.7; 95% CI, 2.8–21.1), McCabe score ≥ 2 (4.58; 1.61–13), age > 65 years (2.92; 1.49–5.74), lactates > 4 mmol/L (2.41; 1.27–4.56), male gender and septic shock (2.23; 1.30–3.83 for each), invasive mechanical ventilation (1.78; 1–3.19), and bilateral pneumonia (1.59; 1.02–2.47). Women with platelets ≤ 100 × 109/L had the highest mortality risk (adjusted OR, 7.7; 2.8–21).

Conclusions

In critically ill patients with PCAP, age, gender, and organ failures at ICU admission were more strongly associated with hospital mortality than were comorbidities. Neither pneumococcal serotype nor antibiotic regimen was associated with hospital mortality.

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Acknowledgements

We thank the ICU physicians who contributed to collect data for the study: Nadia Anguel (CHU Bicêtre, Le Kremlin-Bicêtre, France); Christian Brun-Buisson (Hôpital H. Mondor, Créteil, France); M. Castaner (Hôpital Sud-Sainte Marguerite, Marseille, France); Charles Cerf (Hôpital Foch, Suresnes, France); Christine Cheval (CH Hyères, France); Bernard Clair (Hôpital R. Poincaré, Garches, France); Yves Cohen (Hôpital Avicenne, Bobigny, France); Jean-Michel Constantin (CHU Hôtel Dieu, Clermont Ferrand, France); Aurélie Cravoisy-Brovic (Hôpital Central, Nancy, France); Arnaud Delahaye (CH Rodez, France); N. Fadel (CH Rambouillet, France); Muriel Fartoukh and Antoine Parrot (Hôpital Tenon, Paris, France); Christian Floriot and Christophe Bein (CHI Haute Saône, Vesoul, France); Hugues Georges (CH Tourcoing, France); Claude Gervais (Hôpital Caremeau, Nîmes, France); Dany Goldran-Toledano (Hôpital de Gonesse, France); Jan Hayon and Jean-Claude Lacherade (CHI Poissy-Saint Germain en Laye, France); Kada Klouche (CHU Lapeyronie, Montpellier, France); Sophie Marqué (CHU Rennes, France); Jean-Marc Mazou (CH Dax, France); Hervé Mentec (CH V. Dupouy, Argenteuil, France); Joy Yoganaden Mootien (CH Mulhouse, France); Bruno Mourvillier (GH Bichat, Paris, France); Jean Nouveau (Hôpital Monod, Le Havre, France); Ana Novara (HEGP, Paris, France); Bernard Page (Hôpital A. Paré, Boulogne, France); Antoine Rabbat (Hôtel Dieu, Paris, France); Marie Thuong (CH Delafontaine, Saint-Denis, France); Martial Thyrault (CHG Longjumeau, France); Jean-François Timsit (CHU A. Michaillon, Grenoble, France); Jean-Marie Tonnelier (CHU La Cavale Blanche, Brest, France); and Olivier Zambon (CHU, Nantes, France).

We are grateful to the microbiologists who sent the pneumococcal strains to the French National Reference Centre for Pneumococci (FNRCP): Guillaume Arlet (Hôpital Tenon, Paris, France); Laurence Armand-Lefevre (Hôpital Bichat, Paris, France); Régine Baraduc (CHU Gabriel Montpied, Clermont Ferrand, France); Gilles Berthelot (CH Dieppe, France); Martine Bingen (Hôpital de Gonesse, France); Michel Brun and Christian Carrière (CHU Lapeyronie, Montpellier, France); Annie Buu-Hoi and Emmanuelle Varon (Hôpital Européen Georges Pompidou, Paris, France); Violaine Caillaux (CH Tourcoing, France); Christian Cattoen (CH Valenciennes, France); Guy Chambreuil (CHD Les Oudairies, La Roche sur Yon, France); Chantal Chaplain (CH Delafontaine, Saint-Denis, France); Hubert Chardon (CH du Pays d’Aix, Aix en Provence, France); Mireille Cheron, Michel Leneveu, and Eric Vallée (CHI Poissy, St Germain en Laye, France); Vincent Chieux (Hôpital L. Pasteur, Chartres, France); M.D. Conroy (Hôpital Central, Nancy, France); Jacques Croizé (CHU A. Michaillon, Grenoble, France); Alexandre Doloy and Hélène Poupet (Hôpital Cochin, Paris, France); Pierre-Yves Donnio (CHU, Rennes, France); Florence Doucet-Populaire (Hôpital A. Béclère, Clamart, France); AnneFarges (CHG Longjumeau, France); Jean-Louis Gaillard (Hôpital R. Poincaré, Garches, France); Alain Gravet (CH Mulhouse, France); Bernadette Grignon (CHU J. Bernard, Poitiers, France); Patrick Honderlick (Hôpital Foch, Suresnes, France); Françoise Jaureguy (Hôpital Avicenne, Bobigny, France); Marie-Emmanuelle Juvin (CHU Nantes, France); Marie Kempf (CHU, Angers, France); Marie-Dominique Kitzis (Hôpital St Joseph, Paris, France); Jean-Pierre Laffargue (CH Dax, France); Jean-Philippe Lavigne (Hôpital Caremeau, Nîmes, Frances); Alban Le Monnier (CH Mignot, Le Chesnay, France); Françoise Le Turdu (CH V. Dupouy, Argenteuil, France); P. Legrand (Hôpital H. Mondor, Créteil, France); PierreYves Levy (Hôpital La Timone, Marseille, France); Julien Loubinoux (Hôpital Hôtel Dieu, Paris, France); Morel (Hôpital Monod, Le Havre, France); M.C. Ploy and Delphine Chainier (CHU Dupuytren, Limoges, France); Patrick Pina (CH Rambouillet, France); Didier Poisson (Hôpital La Source, Orléans, France); Annie Raoult (CH Hyères, France); Laurent Raskine (Hôpital Lariboisière, Paris, France); Micheline Roussel-Delvallez (Hôpital A. Calmette, Lille, France); Royer (CHI Haute Saône, Vesoul, France); Cyril Serizer (CH Sud Essonne, Etampes, France); V. Sivadon-Tardy (Hôpital A. Paré, Boulogne, France); Colette Spicq (CHU Bicêtre, Le Kremlin Bicêtre, France); Didier Tandet (CHU La Cavale Blanche, Brest, France); Jacques Tankovic (Hôpital St Antoine, Paris, France); Véronique Vernet-Garnier (Hôpital R. Debré, Reims, France); and Joseph Wattine (CH Rodez, France).

We are indebted to Nathalie Marin and the Clinical Research Unit at the Cochin Teaching Hospital (Paris, France) for centralizing and processing the study data and to A. Wolfe, MD, for helping to prepare the manuscript.

Funding

This study was funded by a 2006 grant from the French public research agency PHRC (#07/061). The study sponsors were two public healthcare and research agencies, namely, the Assistance Publique Hôpitaux de Paris (AP-HP) and the Délégation à la Recherche Clinique et au Développement (DRCD).

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Authors and Affiliations

  1. Réanimation Médico-Chirurgicale, Hôpital A. Mignot, CH Versailles, 177 Rue de Versailles, 78157, Le Chesnay, France

    Jean-Pierre Bedos

  2. Laboratoire de Microbiologie, Centre National de Référence des Pneumocoques, AP-HP Hôpital Européen Georges-Pompidou, 75908, Paris Cedex 15, France

    Emmanuelle Varon

  3. Centre National de Référence des Pneumocoques, Centre Hospitalier Interrcommunal de Créteil, 94000, Créteil, France

    Emmanuelle Varon

  4. Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité (CRESS-UMR1153), Inserm/Université Paris Descartes, Centre d’épidémiologie clinique, Centre Equator France, Hôpital Hôtel-Dieu, 75004, Paris, France

    Raphael Porcher

  5. CHU Angers, Réanimation Médicale, 49933, Angers Cedex 9, France

    Pierre Asfar

  6. CHU Rennes, SMIRM, 35033, Rennes Cedex 9, France

    Yves Le Tulzo

  7. Hôpital Lariboisière, Réanimation Médicale et Toxicologique, 75010, Paris, France

    Bruno Megarbane

  8. Hôpital de La Source, Réanimation Polyvalente, 45067, Orléans Cedex 2, France

    Armelle Mathonnet

  9. CHU Dupuytren, Réanimation Polyvalente, 87042, Limoges, France

    Anthony Dugard

  10. CHU Jean Bernard, Réanimation, 86021, Poitiers Cedex, France

    Anne Veinstein

  11. Hôpital Louis Pasteur, Réanimation, 28018, Chartres Cedex, France

    Kader Ouchenir

  12. CH Sud Essonne, Réanimation Polyvalente, 91152, Etampes Cedex 02, France

    Shidasp Siami

  13. CHU Nantes, Réanimation Médicale, 44093, Nantes Cedex 1, France

    Jean Reignier

  14. Hôpital St Antoine, Réanimation Médicale, 75012, Paris, France

    Arnaud Galbois

  15. Hôpital Robert Debré, Réanimation Polyvalente, 51092, Reims Cedex, France

    Joël Cousson

  16. Hôpital A. Calmette, Réanimation, 59037, Lille Cedex, France

    Sébastien Preau

  17. CH du Pays d’Aix, Réanimation, 13616, Aix En Provence, France

    Olivier Baldesi

  18. CH Dieppe, Réanimation Polyvalente, 76202, Dieppe Cedex, France

    Jean-Philippe Rigaud

  19. CHU Gabriel Montpied, Réanimation Médicale, 63000, Clermont Ferrand, France

    Bertrand Souweine

  20. Hôpital Saint Joseph, Réanimation, 75014, Paris, France

    Benoit Misset

  21. Hôpital Antoine Béclère, Réanimation Médicale, 92140, Clamart, France

    Frederic Jacobs

  22. CH Valenciennes, Réanimation, 59300, Valenciennes, France

    Florent Dewavrin

  23. Hôpital Cochin, Réanimation Médicale, 75679, Paris Cedex 14, France

    Jean-Paul Mira

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  1. Jean-Pierre Bedos
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  2. Emmanuelle Varon
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  3. Raphael Porcher
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  4. Pierre Asfar
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  5. Yves Le Tulzo
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  6. Bruno Megarbane
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  7. Armelle Mathonnet
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  8. Anthony Dugard
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  9. Anne Veinstein
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  12. Jean Reignier
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  13. Arnaud Galbois
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  14. Joël Cousson
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  15. Sébastien Preau
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  16. Olivier Baldesi
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  17. Jean-Philippe Rigaud
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  18. Bertrand Souweine
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  19. Benoit Misset
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  22. Jean-Paul Mira
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Contributions

JPB, EV and JPM are the study guarantors and designed the study; EV and RP extracted and managed the data; RP performed the statistical analysis; and JPB, EV, RP, and JPM wrote the manuscript. All authors included more than 10 patients in the study. All authors read and approved the final version of the manuscript.

Corresponding author

Correspondence to Jean-Pierre Bedos.

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None of the authors have any conflicts of interest to declare.

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Bedos, JP., Varon, E., Porcher, R. et al. Host–pathogen interactions and prognosis of critically ill immunocompetent patients with pneumococcal pneumonia: the nationwide prospective observational STREPTOGENE study. Intensive Care Med 44, 2162–2173 (2018). https://doi.org/10.1007/s00134-018-5444-x

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  • DOI: https://doi.org/10.1007/s00134-018-5444-x

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