Abstract
ObjectivesWe aimed to investigate the association between the time to positivity of blood culture (TTP) with clinical outcome and severity of pneumococcal bacteremic pneumonia.MethodsProspective observational study carried out in 278 hospitalized adult CAP patients with positive blood culture for Streptococcus pneumonia (2003–2015).ResultsA total of 278 cases of bacteremic pneumococcal pneumonia were analyzed, median age 62 (46; 79) years. Fifty-one percent of the cases had PSI IV-V. Twenty-one (8%) died within 30-days after admission. The analysis of the TTP showed that the first quartile of the TTP (9.2h) was the best cut-off for differentiating 2 groups of patients at risk, early (TTP <9.2 h) and late (TTP ≥9.2 h) detection groups (AUC 0.66 [95% CI 0.53 to 0.79]). Early TTP was associated with a statistically significant risk of invasive mechanical ventilation (18% vs. 6%, p = 0.007), longer length of hospital stay (12 days vs. 8 days, p<0.001), higher in-hospital mortality (15% vs. 4%, p = 0.010), and 30-day mortality (15% vs. 5%, p = 0.018). After adjustment for potential confounders, regression analyses revealed early TTP as independently associated with high risk of invasive mechanical ventilation (OR 4.60, 95% CI 1.63 to 13.03), longer length of hospital stay (β 5.20, 95% CI 1.81 to 8.52), higher in-hospital mortality (OR 5.35, 95% CI 1.55 to 18.53), and a trend to higher 30-day mortality (OR 2.47, 95% CI 0.85 to 7.21) to be a contributing factor.ConclusionOur results demonstrate that TTP is an easy to obtain surrogate marker of the severity of pneumococcal pneumonia and a good predictor of its outcome.
Highlights
Streptococcus pneumoniae remains the most frequent cause of community-acquired pneumonia (CAP) [1,2]
The analysis of the time to positivity (TTP) showed that the first quartile of the TTP (9.2h) was the best cut-off for differentiating 2 groups of patients at risk, early (TTP
After adjustment for potential confounders, regression analyses revealed early TTP as independently associated with high risk of invasive mechanical ventilation, longer length of hospital stay (β 5.20, 95% CI 1.81 to 8.52), higher in-hospital mortality, and a trend to higher 30-day mortality to be a contributing factor
Summary
Streptococcus pneumoniae remains the most frequent cause of community-acquired pneumonia (CAP) [1,2]. Bacteremia is documented in 25% of cases [3] and their mortality is 15% to 26% greater than in non-bacteremic patients [4]. The identification of early predictors of worse outcome in patients with bacteremic CAP due to S. pneumoniae is of utmost importance. There is evidence about the association between the high bacterial load and worse clinical outcomes in invasive pneumococcal pneumonia [5,6]. This evidence suggests that determination of pneumococcal load has a clinical utility. TTP is inversely associated with blood bacterial load (8) and is a reasonable marker of more severe disease and a potential early predictor of mortality
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