Introduction and Objectives Bacteraemia secondary to pneumococcal pneumonia is the most common presentation of invasive pneumococcal disease (IPD) and is associated with high mortality rates.¹ We conducted this study to evaluate differences in the process of care and outcome in patients with community-acquired invasive pneumococcal pneumonia (CAIPP) depending on age, co-morbidities and vaccination status.

Methods This was a retrospective study that analysed the data for patients with CAIPP who were hospitalised in 2016 at NHS Lanarkshire hospitals.

Results Forty-five of 60 patients with pneumococcal bacteraemia had IPD secondary to community-acquired pneumonia. The mean age of the patients was 61 years (17–101). The CURB 65 score was 0–1 in 55% patients, 2 in 12% and 3–5 in 33%. Overall 30 days mortality was 22%. The odds ratio of death within 30 days from CAIPP was 15.9 (95% CI: 1.8–140, p=0.012) among those who had any co-morbidity involving major organ (cardiac, respiratory, renal or liver failure). Thirty days mortality showed the strongest positive association with age (r=0.46, p=0.001) therefore patients were divided into two groups according to their age (Table 1). There was no difference between groups in time to reach diagnosis or initiate treatment. Within 4 hours of admission, a chest x-ray was obtained in 88% in Group 1 vs. 89% in Group 2 (p=NS), and the first dose of antibiotics was administered within 4 hours in 90% in Group 1 vs. 94% in Group 2 (p=NS). 79% patients in Group 2 had at least one major co-morbidity vs. 46% in Group 1 (p=0.012). Group 2 had significantly higher 30 days mortality than group 1, 47% vs 3.8% (p=0.002). In the Group 2, among deceased 44% (4 of 9) have not received pneumococcal vaccination. Only 4 of 26 patients in Group 1 were vaccinated against Streptococcus pneumonia.

Conclusions Clinical significance of IPP is underestimated in older people. Despite satisfactory initial assessment and prompt treatment mortality remains very high. That could be associated with the presence of co-morbidities and insufficient level of pneumococcal vaccination.

Reference

1. Ludwig Eet al. The remaining challenges of pneumococcal disease in adults. Eur Respir Rev 2012;21:57–65.