Dept of Pneumology, Hospital Clinic of Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Ciber de Enfermedades Respiratorias (CIBERES), Barcelona, Spain.
Respiratory Dept, Sotiria Chest Diseases Hospital, Athens, Greece.
Eur Respir J. 2016 Sep;48(3):797-807. doi: 10.1183/13993003.00039-2016. Epub 2016 May 12.
In patients with pneumococcal community-acquired pneumonia (CAP), the risk factors for bacteraemia and its impact on outcomes are not fully elucidated. We aimed to compare characteristics of patients with blood-culture-positive versus blood-culture-negative pneumococcal CAP, and to characterise bacteraemic serotypes.We describe a prospective, observational study on nonimmunocompromised patients with pneumococcal CAP, from 1996 to 2013. We define severe pneumonia according to American Thoracic Society/Infectious Diseases Society of America guidelines.Of a total of 917 patients with pneumococcal CAP, 362 had blood-culture-positive pneumococcal pneumonia (BCPPP; 39%). High C-reactive protein (CRP) (≥20 mg·dL(-1)) (odds ratio (OR) 2.36, 95% CI 1.45-3.85), pleural effusion (OR 2.03, 95% CI 1.13-3.65) and multilobar involvement (OR 1.69, 95% CI 1.02-2.79) were independently associated with bacteraemic CAP, while nursing home resident (OR 0.12, 95% CI 0.01-1.00) was found as a protective factor. Despite the clinical differences, BCPPP showed similar outcomes to blood-culture-negative pneumococcal pneumonia (BCNPP). 14% of the serotypes (period 2006-2013) causing bacteraemia are included in pneumococcal conjugate vaccine PVC7, 74% in pneumococcal conjugate vaccine PVC13 and 83% in pneumococcal polysaccharide vaccine PPSV23.Pleural effusion, a high level of CRP and multilobar involvement predicted an increased risk of BCPPP. Although BCPPP patients were more severely ill at admission, mortality was not significantly greater than in BCNPP patients.
在患有社区获得性肺炎（CAP）的肺炎球菌患者中，菌血症的危险因素及其对结局的影响尚不完全清楚。我们旨在比较血培养阳性与血培养阴性肺炎球菌 CAP 患者的特征，并对菌血症血清型进行特征描述。
我们描述了一项针对非免疫功能低下的肺炎球菌 CAP 患者的前瞻性观察性研究，研究时间为 1996 年至 2013 年。我们根据美国胸科学会/传染病学会的指南定义严重肺炎。
在总共 917 例肺炎球菌 CAP 患者中，362 例血培养阳性肺炎球菌性肺炎（BCPPP；39%）。高 C 反应蛋白（CRP）（≥20mg·dL（-1））（优势比（OR）2.36，95%置信区间（CI）1.45-3.85）、胸腔积液（OR 2.03，95% CI 1.13-3.65）和多肺叶受累（OR 1.69，95% CI 1.02-2.79）与菌血症性 CAP 独立相关，而疗养院居民（OR 0.12，95% CI 0.01-1.00）则为保护因素。尽管存在临床差异，但 BCPPP 与血培养阴性肺炎球菌性肺炎（BCNPP）的结局相似。在导致菌血症的血清型中，14%（2006-2013 年期间）包含在肺炎球菌结合疫苗 PVC7 中，74%包含在肺炎球菌结合疫苗 PVC13 中，83%包含在肺炎球菌多糖疫苗 PPSV23 中。胸腔积液、高水平 CRP 和多肺叶受累预测了发生 BCPPP 的风险增加。尽管 BCPPP 患者入院时病情更严重，但死亡率并未明显高于 BCNPP 患者。
