Bacteremic pneumococcal pneumonia: clinical outcomes and preliminary results of inflammatory response

J. M. Bordon, R. Fernandez-Botran, T. L. Wiemken, P. Peyrani, S. M. Uriarte, F. W. Arnold, L. Rodriquez-Hernandez, M. J. Rane, R. R. Kelley, L. E. Binford, S. Uppatla, R. Cavallazzi, F. Blasi, S. Aliberti, M. I. Restrepo, S. Fazeli, A. Mathur, M. Rahmani, K. Ayesu, J. Ramirez

Research output: Contribution to journalArticle

18 Scopus citations

Abstract

Purpose: Further examination of clinical outcomes and inflammatory response of bacteremic pneumococcal community-acquired pneumonia (CAP) is of great interest to enhance the care of patients with pneumococcal CAP. Methods: This is a secondary analysis of the Community Acquired Pneumonia Organization (CAPO) to compare the time to clinical stability (TCS), length of hospital stay (LOS), and in-hospital mortality of hospitalized pneumococcal CAP patients with and without bacteremia. To measure the effect of bacteremia in pneumococcal CAP patients on outcomes, we modeled all-cause in-hospital mortality using a Poisson regression model, and TCS and LOS using Cox proportional hazards models. Adjusted multivariate regression models were also used to predict the probability of occurrence of each of the study outcomes. To investigate the inflammatory response, we measured the plasma levels of pro- and anti-inflammatory cytokines [tumor necrosis factor (TNF)-α, interleukin (IL)-1rα, IL-6, IL-8, IL-10], inflammatory biomarkers [C-reactive protein (CRP), pro-calcitonin (PCT), and B-type natriuretic peptide (BNP)], and peripheral blood neutrophil responses in 10 patients, 4 bacteremic and 6 non-bacteremic pneumococcal CAP, upon admission and every other day during the first 6 days of hospitalization. Functional data were presented as median and standard error of the median (SEM); due to small number of samples no statistical comparisons were performed between groups. Results: From 833 pneumococcal CAP patients, 394 patients (47 %) were bacteremic. Bacteremic pneumococcal CAP were less likely to reach TCS with an adjusted hazard ratio (AHR) of 0.82 (95 % CI 0.69–0.97; p = 0.02) and had higher in-hospital mortality with an AHR of 1.63 (95 % CI 1.06–2.50, p = 0.026). Bacteremic pneumococcal CAP patients had a longer LOS than non-bacteremic pneumococcal CAP (p 

Original languageEnglish (US)
Pages (from-to)729-738
Number of pages10
JournalInfection
Volume43
Issue number6
DOIs
StatePublished - Dec 1 2015

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Keywords

  • Biomarkers
  • Chemokines
  • Community-acquired pneumonia
  • Cytokines
  • Inflammatory response
  • Mortality
  • Neutrophil functional responses
  • Outcome
  • Pneumococcal bacteremia
  • Pneumonia severity
  • Streptococcus pneumoniae

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

Cite this

Bordon, J. M., Fernandez-Botran, R., Wiemken, T. L., Peyrani, P., Uriarte, S. M., Arnold, F. W., Rodriquez-Hernandez, L., Rane, M. J., Kelley, R. R., Binford, L. E., Uppatla, S., Cavallazzi, R., Blasi, F., Aliberti, S., Restrepo, M. I., Fazeli, S., Mathur, A., Rahmani, M., Ayesu, K., & Ramirez, J. (2015). Bacteremic pneumococcal pneumonia: clinical outcomes and preliminary results of inflammatory response. Infection, 43(6), 729-738. https://doi.org/10.1007/s15010-015-0837-z