Determinants of Outcome in Patients With Bacteraemic Pneumococcal Pneumonia: Importance of Early Adequate Treatment

Scand J Infect Dis. 2010 Mar;42(3):185-92. doi: 10.3109/00365540903418522.

Abstract

We set out to determine the factors influencing mortality in 125 adult patients with bacteraemic pneumococcal community-acquired pneumonia (CAP), assessing the impact on outcomes of early adequate therapy in particular. Presumed prognostic factors with p < 0.1 in the unadjusted model were subjected to multivariate Cox regression analysis, with in-hospital and 90-day mortalities as the dependent variables. A time period of >4 h from admission to start of adequate antibiotic treatment (adjusted hazard ratio (aHR) 2.62, 95% confidence interval (CI) 1.06-6.45; p =0.037) and severe sepsis or septic shock (aHR 5.06, 95% CI 1.63-15.71; p = 0.005) were independently associated with in-hospital mortality. Variables associated with 90-day mortality were Charlson comorbidity index (aHR 1.17, 95% CI 1.02-1.34; p = 0.018), severe sepsis or septic shock (aHR 3.03, 95% CI 1.22-7.51; p = 0.016) and delay of adequate antibiotic therapy >4 h (aHR 2.21, 95% CI 1.01-4.86; p = 0.048). The use of combination therapy was not included in these models but was a protective factor for delayed adequate therapy (aHR 0.53, 95% CI 0.29-0.95; p = 0.033). Administration of adequate antimicrobial therapy within 4 h of arrival is a critical determinant of survival in patients with bacteraemic pneumococcal CAP.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anti-Bacterial Agents / therapeutic use*
  • Bacteremia / drug therapy*
  • Bacteremia / mortality*
  • Humans
  • Pneumonia, Pneumococcal / complications
  • Pneumonia, Pneumococcal / drug therapy*
  • Pneumonia, Pneumococcal / mortality*
  • Risk Factors
  • Time Factors
  • Treatment Outcome

Substances

  • Anti-Bacterial Agents