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The Presence of Pneumococcal Bacteremia Does Not Influence Clinical Outcomes in Patients With Community-Acquired Pneumonia^*

Results From the Community-Acquired Pneumonia Organization (CAPO) International Cohort Study

^* From the Department of Medicine (Dr. Bordón), Section of Infectious Diseases, Providence Hospital, Washington, DC; the Division of Infectious Diseases (Drs. Peyrani and Ramirez), University of Louisville Medical School, Louisville, KY; the Department of Bioinformatics and Biostatistics (Dr. Brock), School of Public Health and Information Sciences, University of Louisville, Louisville, KY; Istituto Malattie Respiratorie (Dr. Blasi), Università degli Studi di Milano, Ospedale Maggiore Milano, Milan, Italy; the Critical Care Department (Dr. Rello), Joan XXIII University Hospital, Tarragona, Spain; and the Department of Medicine (Dr. File), Summa Health System, Akron, OH.

Correspondence to: José Bordón, MD, PhD, Providence Hospital, Department of Medicine, Section of Infectious Diseases, 1150 Varnum St, NE, Washington, DC 20017; e-mail: bordonjose{at}yahoo.com

Abstract

Background: It remains unknown whether pneumococcal bacteremia increases the risk of poor outcomes in hospitalized patients with community-acquired pneumonia (CAP). The objective of this study was to investigate whether the presence of pneumococcal bacteremia influences the clinical outcomes of hospitalized patients with CAP.

Methods: We performed secondary analyses of the Community-Acquired Pneumonia Organization database of hospitalized patients with CAP and pneumococcal bacteremia, and patients with CAP and negative blood culture findings. To identify the effect of pneumococcal bacteremia on patient outcomes, we modeled all-cause mortality and CAP-related mortality using logistic regression analysis, and time to clinical stability and length of hospital stay using Cox proportional hazards models.

Results: We studied 125 subjects with pneumococcal bacteremic CAP and 1,847 subjects with nonbacteremic CAP. The multivariable regression analysis revealed a lack of association of pneumococcal bacteremic CAP and time to clinical stability (hazard ratio, 0.87; 95% confidence interval [CI], 0.7 to 1.1; p = 0.25), length of hospital stay (hazard ratio, 1.14; 95% CI, 0.91 to 1.43; p = 0.25), all-cause mortality (odds ratio [OR], 0.68; 95% CI, 0.36 to 1.3; p = 0.25), and CAP-related mortality (OR, 0.86; 95% CI, 0.35 to 2.06; p = 0.73).

Conclusions: Pneumococcal bacteremia does not increase the risk of poor outcomes in patients with CAP. Factors related to severity of disease are confounders of the association between pneumococcal bacteremia and poor outcomes. This study indicates that the presence of pneumococcal bacteremia by itself should not be a contraindication for deescalation of therapy in clinically stable hospitalized patients with CAP.

Key Words: bacteremia • community-acquired pneumonia • Pneumococcus