Bellut Hugo, Porcher Raphael, Varon Emmanuelle, Asfar Pierre, Le Tulzo Yves, Megarbane Bruno, Mathonnet Armelle, Dugard Anthony, Veinstein Anne, Ouchenir Kader, Siami Shidasp, Reignier Jean, Galbois Arnaud, Cousson Joël, Preau Sébastien, Baldesi Olivier, Rigaud Jean-Philippe, Souweine Bertrand, Misset Benoit, Jacobs Frederic, Dewavrin Florent, Mira Jean-Paul, Bedos Jean-Pierre
Réanimation Médico‑Chirurgicale, Hôpital A. Mignot, CH Versailles, 177 Rue de Versailles, 78157, Le Chesnay, France.
Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité (CRESS‑UMR1153), Inserm, Centre d'épidémiologie clinique, Centre Equator France, Hôpital Hôtel-Dieu, Université Paris Descartes, 75004, Paris, France.
Ann Intensive Care. 2021 Oct 24;11(1):148. doi: 10.1186/s13613-021-00936-z.
The presence of bacteraemia in pneumococcal pneumonia in critically ill patients does not appear to be a strong independent prognostic factor in the existing literature. However, there may be a specific pattern of factors associated with mortality for ICU patients with bacteraemic pneumococcal community-acquired pneumonia (CAP). We aimed to compare the factors associated with mortality, according to the presence of bacteraemia or not on admission, for patients hospitalised in intensive care for severe pneumococcal CAP.
This was a post hoc analysis of data from the prospective, observational, multicentre STREPTOGENE study in immunocompetent Caucasian adults admitted to intensive care in France between 2008 and 2012 for pneumococcal CAP. Patients were divided into two groups based on initial blood culture (positive vs. negative) for Streptococcus pneumoniae. The primary outcome was hospital mortality, which was compared between the two groups using odds ratios according to predefined variables to search for a prognostic interaction present in bacterial patients but not non-bacteraemic patients. Potential differences in the distribution of serotypes between the two groups were assessed. The prognostic consequences of the presence or not of initial bi-antibiotic therapy were assessed, specifically in bacteraemic patients.
Among 614 included patients, 274 had a blood culture positive for S. pneumoniae at admission and 340 did not. The baseline difference between the groups was more frequent leukopaenia (26% vs. 14%, p = 0.0002) and less frequent pre-hospital antibiotic therapy (10% vs. 16.3%, p = 0.024) for the bacteraemic patients. Hospital mortality was not significantly different between the two groups (p = 0.11). We did not observe any prognostic factors specific to the bacteraemic patient population, as the statistical comparison of the odds ratios, as an indication of the association between the predefined prognostic parameters and mortality, showed them to be similar for the two groups. Bacteraemic patients more often had invasive serotypes but less often serotypes associated with high case fatality rates (p = 0.003). The antibiotic regimens were similar for the two groups. There was no difference in mortality for patients in either group given a beta-lactam alone vs. a beta-lactam combined with a macrolide or fluoroquinolone.
Bacteraemia had no influence on the mortality of immunocompetent Caucasian adults admitted to intensive care for severe pneumococcal CAP, regardless of the profile of the associated prognostic factors.
在现有文献中，重症患者肺炎球菌肺炎伴菌血症似乎并非强有力的独立预后因素。然而，对于患有菌血症性肺炎球菌社区获得性肺炎（CAP）的重症监护病房（ICU）患者，可能存在与死亡率相关的特定因素模式。我们旨在比较因严重肺炎球菌CAP入住重症监护病房的患者，根据入院时是否存在菌血症，与死亡率相关的因素。
这是一项对前瞻性、观察性、多中心STREPTOGENE研究数据的事后分析，该研究针对2008年至2012年期间因肺炎球菌CAP入住法国重症监护病房的免疫功能正常的白种成年人。根据肺炎链球菌的初始血培养结果（阳性与阴性）将患者分为两组。主要结局是医院死亡率，根据预定义变量使用比值比在两组之间进行比较，以寻找菌血症患者而非非菌血症患者中存在的预后相互作用。评估两组之间血清型分布的潜在差异。评估初始双联抗生素治疗与否的预后后果，特别是在菌血症患者中。
在纳入的614例患者中，274例入院时血培养肺炎链球菌阳性，340例阴性。菌血症患者组间基线差异为白细胞减少更常见（26%对14%，p = 0.0002），院前抗生素治疗更少见（10%对16.3%，p = 0.024）。两组的医院死亡率无显著差异（p = 0.11）。我们未观察到菌血症患者群体特有的任何预后因素，因为作为预定义预后参数与死亡率之间关联指标的比值比的统计比较显示，两组相似。菌血症患者侵袭性血清型更常见，但与高病死率相关的血清型更少见（p = 0.003）。两组的抗生素治疗方案相似。单独使用β-内酰胺类药物与β-内酰胺类药物联合大环内酯类或氟喹诺酮类药物治疗的两组患者死亡率无差异。
菌血症对因严重肺炎球菌CAP入住重症监护病房的免疫功能正常的白种成年人的死亡率无影响，无论相关预后因素情况如何。
