KALIN M, ORTQVIST A, ALMELA M, AUFWERBER E, DWYER R, HENRIQUES B, JORUP C, JULANDER I, MARRIE TJ, MUFSON MA, RIQUELME R, THALME A, TORRES A, WOODHEAD MA; Interscience Conference on Antimicrobial Agents and Chemotherapy.
Abstr Intersci Conf Antimicrob Agents Chemother Intersci Conf Antimicrob Agents Chemother. 1999 Sep 26-29; 39: 675 (abstract no. 1068).
Karolinska Inst., Stockholm, SWEDEN
BACKGROUND: The case fatality rate in bacteremic pneumococcal disease is reported to be around 20%, but in a previous retrospective study we found a rate of 5% Stockholm, Sweden (STO) and of 26% in Huntington, WV, USA (HWV).METHODS: To try to define the influence of prognostic factors in patients with community-acquired pneumococcal bacteremia, a 2-year prospective study was performed in five centers: HWV and STO, Manchester, UK (MAN), Barcelona, Spain (BAR) and Halifax, Canada (HAL).RESULTS: A total of 460 patients were included (STO 290, BAR 75, HWV 49, MAN 30, HAL 16). A high risk of death was significantly associated with high age, nursing home living, chronic pulmonary disease, and chronic cardiac disease with heart failure. Of 34 patients with meningitis 26% died. Of 365 patients with pneumonia without meningitis 11% died, 19% of those with 2 lobes affected and 7% of those with only one lobe involved (p=0.0016). The mean Apache II score was 12; patients with a lower score had a case fatality rate of only 2.6%, while for those with a higher score it was 21%. In a multivariate analysis age >65 years (OR 2.2), nursing home living (2.8), presence of chronic pulmonary disease (2.5), high acute physiology (of the Apache II) score (APS) (OR 7.6, 22, and 41 for scores 9-14, 15-17 and >17), and need for mechanical ventilation (OR 4.4) were found to be independent predictors of death. The case fatality rate differed significantly between the centers: 20% in HWV and BAR, 13% in MAN, 8% in STO and 6% in HAL. High Apache II score and need for mechanical ventilation (BAR only) and frequency and impact of nursing home living and underlying chronic diseases, were factors of probable importance for different outcomes.CONCLUSION: The Apache II score predicted the prognosis of bacteremic, pneumococcal disease with excellent accuracy. High APS score, high age, nursing home living, presence of chronic pulmonary disease and need for mechanical ventilation were independent predictors of a serious prognosis. Differences of their appearance in the different centers seemed contributed to different prognoses.
Publication Types:
Keywords:
- APACHE
- Canada
- Chronic Disease
- Humans
- Male
- Prognosis
- Prospective Studies
- Retrospective Studies
- Spain
- Streptococcus pneumoniae
- Sweden
Other ID:
UI: 102246374
From Meeting Abstracts