Abstract
Serious Streptococcus pneumoniae infections, encompassing pneumonia, bacteremia, and meningitis, are a major cause of mortality. However, literature regarding mortality is often limited to invasive pneumococcal disease, excluding pneumonia. This study sought to identify predictors of mortality among adults with serious pneumococcal disease, including pneumonia and invasive pneumococcal disease. This was a nested case-control study of unvaccinated older Veterans with positive S. pneumoniae cultures (blood, cerebrospinal fluid, respiratory) admitted to Veterans Affairs medical centers nationally between 2002 and 2011. Patients vaccinated against pneumococcal disease were excluded. Using multivariable logistic regression, predictors of 30-day mortality were identified, including patient demographics, comorbidities during admission, and medical history within the previous year. Among 9,468 patients, there were 9,730 serious pneumococcal infections; 1,764 (18.6%) resulted in death within 30 days (cases), whereas 7,966 did not (controls). Pneumonia accounted for half (49.4%, n=871) of all deaths. Mortality predictors consistent with vaccine recommendations included dialysis (during hospitalization, OR=3.35, 95% CI=2.37, 4.72), moderate to severe liver disease (during hospitalization, OR=2.47, 95% CI=1.53, 3.99; within 1 year, OR=1.49, 95% CI=1.01, 2.20), and neutropenia (during hospitalization, OR=2.67, 95% CI=1.32, 5.42). Predictors not included in current recommendations included dementia (during hospitalization, OR=1.8, 95% CI=1.23, 2.61) and neurologic disorders (during hospitalization, OR=1.86, 95% CI=1.42, 2.45; within 1 year, OR=1.28, 95% CI=1.02, 1.59). Several mortality predictors among unvaccinated Veterans with serious pneumococcal disease were consistent with pneumococcal vaccine recommendations, including organ or immune system dysfunction-related conditions. Other predictors, including neurologic disorders or dementia, may warrant expanded vaccination recommendations.
Highlights
Serious Streptococcus pneumoniae infections, encompassing pneumonia, bacteremia, and meningitis, are a major cause of mortality
Streptococcus pneumoniae is a leading cause of morbidity and mortality worldwide, much of which is the result of serious pneumococcal infections, including pneumonia, bacteremia, and meningitis.[1,2]
Study Population This was a national nested case-control study of Veterans aged ≥50 years requiring inpatient care for serious pneumococcal disease between January 1, 2002 and December 31, 2011.11 Adults aged ≥50 years were selected as they are at the highest risk of developing these serious pneumococcal infections.[5]
Summary
Serious Streptococcus pneumoniae infections, encompassing pneumonia, bacteremia, and meningitis, are a major cause of mortality. Streptococcus pneumoniae is a leading cause of morbidity and mortality worldwide, much of which is the result of serious pneumococcal infections, including pneumonia, bacteremia, and meningitis.[1,2] invasive pneumococcal disease, which encompasses bacteremia and meningitis, results in more than 15,000 hospitalizations and a mortality of at least 15%, much of the burden of serious pneumococcal disease is related to pneumonia.[2] In the U.S alone, an estimated 900,000 individuals develop pneumococcal pneumonia annually, resulting in approximately 400,000 hospitalizations.[1,2,3] Though mortality for pneumococcal pneumonia is only 5%–7% overall, this includes less severe pneumonias managed in the outpatient setting.[5] Mortality in adults aged 65 years and older and those requiring hospitalization is approximately 15%, as these individuals may be more susceptible to complications, including development of bacteremia.[1,2,3,4]. Despite the burden of pneumococcal pneumonia, studies assessing predictors of mortality associated with serious pneumococcal disease have focused primarily on patients with invasive pneumococcal disease only, excluding patients with nonbacteremic pneumonia.[1,2] As such, the purpose of this study was to identify independent predictors of mortality among unvaccinated adults with serious pneumococcal disease, including pneumonia and invasive pneumococcal disease
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