Prognostic Factors of Severe Bacteraemic Pneumococcal Pneumonia in Critically Ill Immunocompetent Patients: A STREPTOGENE Sub-Study

Abstract Background : The presence of bacteraemia in pneumococcal pneumonia in critically ill patient does not appear to be a strong prognostic factor on its own from the existing literature, but there may be a specific pattern of factors associated with mortality in ICU patients with bacteraemic pneumococcal pneumococcal community-acquired pneumonia (CAP).We aimed to identify factors associated with mortality in patients admitted to intensive care for severe bacteraemic CAP. Methods : This is a post-hoc analysis of data from the prospective, observational, multicentre STREPTOGENE study in immunocompetent Caucasian adults admitted to intensive care in France, between 2008 and 2012, for bacteraemic pneumococcal CAP documented by culture and/or urinary antigenuria. Patients were divided into two groups based on initial blood culture positivity for Streptococcus pneumoniae . The primary outcome was hospital mortality. Serotypes of 339 S. pneumoniae strains were determined. Results : Of 614 included patients, 274 did and 340 did not have a blood culture positive for S. pneumoniae at admission. The only baseline difference between the groups was more frequent leukopenia in bacteraemic patients (26% vs. 14%, p =0.0002). Hospital mortality was not significantly different between groups ( p =0.11). The associations between the various prognostic parameters studied and mortality were similar in the two groups. Bacteraemic patients more often had invasive serotypes but less often had serotypes associated with high case-fatality rates ( p =0.003). Antibiotic regimens were similar in the two groups. In neither group was mortality different in patients given a beta-lactam alone vs. a beta-lactam combined with a macrolide or fluoroquinolone. Interpretation : In immunocompetent Caucasian adults admitted to intensive care for severe pneumococcal CAP, bacteraemia had no influence on mortality, regardless of the prognostic factor profile. A prospective randomised trial is warranted to confirm the absence of superiority of one treatment over others.