Pneumococcal pneumonia presenting with septic shock: host- and pathogen-related factors and outcomes
- 1Infectious Disease Department of Hospital Universitari de Bellvitge, Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), Spanish Network for the Research in Infectious Diseases (REIPI), University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
- 2Microbiology Department of Hospital Universitari de Bellvitge, Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), Ciber de Enfermedades Respiratorias (CIBERES), University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
- 3Respiratory Department of Hospital Universitari de Bellvitge, Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
- Correspondence to Dr J Carratalà, Infectious Disease Department, Hospital Universitari de Bellvitge, Feixa Llarga s/n, 08907 L’Hospitalet de Llobregat, Barcelona, Spain; jcarratala{at}ub.edu
- Received 14 July 2009
- Accepted 14 October 2009
- Published Online First 8 December 2009
Abstract
Background: Host- and pathogen-related factors associated with septic shock in pneumococcal pneumonia are not well defined. The aim of this study was to identify risk factors for septic shock and to ascertain patient outcomes. Serotypes, genotypes and antibiotic resistance of isolated strains were also analysed.
Methods: Observational analysis of a prospective cohort of non-severely immunosuppressed hospitalised adults with pneumococcal pneumonia. Septic shock was defined as a systolic blood pressure of <90 mm Hg and peripheral hypoperfusion with the need for vasopressors for >4 h after fluid replacement.
Results: 1041 patients with pneumococcal pneumonia diagnosed by Gram stain and culture of appropriate samples and/or urine antigen test were documented, of whom 114 (10.9%) had septic shock at admission. After adjustment, independent risk factors for shock were current tobacco smoking (OR, 2.11; 95% CI, 1.02 to 4.34; p = 0.044), chronic corticosteroid treatment (OR, 4.45; 95% CI, 1.75 to 11.32; p = 0.002) and serotype 3 (OR, 2.24; 95% CI, 1.12 to 4.475; p = 0.022). No significant differences were found in genotypes and rates of antibiotic resistance. Compared with the remaining patients, patients with septic shock required mechanical ventilation more frequently (37% vs 4%; p<0.001) and had longer length of stay (11 vs 8 days; p<0.001). The early (10% vs 1%; p<0.001) and overall case fatality rates (25% vs 5%; p<0.001) were higher in patients with shock.
Conclusions: Septic shock is a frequent complication of pneumococcal pneumonia and causes high morbidity and mortality. Current tobacco smoking, chronic corticosteroid treatment and infection caused by serotype 3 are independent risk factors for this complication.
Footnotes
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Funding This study was supported by research grant REIPI RD06/0008 from the Ministerio de Sanidad y Consumo, Instituto de Salud Carlos III, Spanish Network for the Research in Infectious Diseases; CIBER de Enfermedades Respiratorias (CIBERES; CB06/06/0037), which is a project run by the ISCIII (Instituto de Salud Carlos III), Madrid, Spain; Fondo de Investigación Sanitaria de la Seguridad Social (grants 04/0139, 07/0864 and PI060647); and by Institut d’Investigació Biomèdica de Bellvitge (CG-V). We acknowledge the use of the Streptococcus pneumoniae MLST web site at Imperial College London, which is funded by the Wellcome Trust. We are grateful to M. Alegre for her excellent technical support.
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Competing interests None.
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Ethics approval The study was approved by the Ethics Committee of theHospital Universitari de Bellvitge.
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Provenance and Peer review Not commissioned; externally peer reviewed.
