The Burden of Pneumococcal Pneumonia – Experience of the German Competence Network CAPNETZ

 

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Abstract

Background: Pneumococcal pneumonia is still an important cause of mortality. The objective of this study was to compare frequency, clinical presentation, outcome and vaccination status of patients with pneumococcal community-acquired pneumonia (CAP) to CAP due to other or no detected pathogen based on data of the German Network for community-acquired pneumonia (CAPNETZ).

Methods: Demographic, clinical and diagnostic data were recorded using standardized web-based data acquisition. Standardized microbiological sampling and work-up were conducted in each patient.

Results: 7400 patients with CAP from twelve clinical centers throughout Germany were included. In 2259 patients (32 %) a pathogen was identified, Streptococcus pneumonia being the most frequent (n = 676, 30 % of all patients with identified pathogens). Compared to those with non-pneumococcal pneumonia, patients with pneumococcal pneumonia were more frequently admitted to hospital (80 % vs. 66 %, p < 0.001), had higher CURB score values on admission, had more frequently pleural effusion (19 % vs. 14 %, p = 0.001) and needed more frequently oxygen insufflation (58 % vs. 44 %, p < 0.001). There was no relevant difference in overall mortality.

Conclusions: Pneumococcal pneumonia was associated with a more severe clinical course demanding more medical resources as compared to non-pneumococcal pneumonia.

Zusammenfassung

Hintergrund: Trotz Verfügbarkeit wirksamer Antibiotika ist die Pneumokokkenpneumonie weiterhin mit einer relevanten Mortalität belastet. In der vorliegenden Arbeit wurden Häufigkeit, Symptomatik, Verlauf und Impfstatus von Patienten mit ambulant erworbener Pneumonie mit und ohne Nachweis von Pneumokokken verglichen.

Methoden: Demographische, klinische und diagnostische Daten wurden über ein internet-basiertes Formular erfasst. Bei jedem Patienten wurde eine standardisierte mikrobiologische Diagnostik durchgeführt.

Ergebnisse: 7400 Patienten mit ambulant erworbener Pneumonie wurden in 12 deutschen Studienzentren eingeschlossen. Bei 2259 Patienten (32 %) wurde ein Erreger identifiziert, dabei wurden Pneumokokken am häufigsten nachgewiesen (n = 676, 30 % aller Patienten mit Erregernachweis). Patienten mit Pneumokokkennachweis wurden häufiger hospitalisiert (80 % vs 66 %, p < 0.001), hatten einen höheren CURB-Punktwert bei Studieneinschluss, entwickelten häufiger einen Pleuraerguss (19 % vs 14 %, p = 0.001) und benötigten häufiger eine Sauerstoffinsufflation (58 % vs 44 %, p < 0.001). Es gab keinen signifikanten Unterschied in der Letalität.

Schlussfolgerung: Patienten mit Pneumokokkenpneumonien zeigten einen schwereren Verlauf und erforderten eine komplexere medizinische Versorgung als Patienten, bei denen keine Pneumokokken nachgewiesen wurden.

^* for the CAPNETZ Study Group

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