Twenty-year trend in mortality among hospitalized patients with pneumococcal community-acquired pneumonia

被引:29
|
作者
Cilloniz, Catia [1 ]
Liapikou, Adamantia [2 ]
Martin-Loeches, Ignacio [3 ]
Garcia-Vidal, Carolina [4 ]
Gabarrus, Albert [1 ]
Ceccato, Adrian [1 ]
Magdaleno, Daniel [5 ]
Mensa, Josep [4 ]
Marco, Francesc [6 ]
Torres, Antoni [1 ]
机构
[1] Univ Barcelona, Hosp Clin Barcelona, SGR Ciber Enfermedades Resp Ciberes,Dept Pneumol, Inst Invest Biomed August Pi & Sunyer IDIBAPS,Ins, Barcelona, Spain
[2] Sotiria Chest Dis Hosp, Resp Dept, Athens, Greece
[3] Trinity Coll Dublin, St Jamess Univ Hosp, Dept Clin Med, MICRO, Dublin, Ireland
[4] Hosp Clin Barcelona, Dept Infect Dis, Barcelona, Spain
[5] Natl Polytech Inst Mexico City, Super Med Sch, Mexico City, DF, Mexico
[6] Univ Barcelona, Hosp Clin Barcelona, Barcelona Ctr Int Hlth Res CRESIB, Dept Microbiol Biomed Diagnost Ctr CDB,ISGlobal, Barcelona, Spain
来源
PLOS ONE | 2018年 / 13卷 / 07期
关键词
GUIDELINES; MANAGEMENT; ADULTS; SEVERITY; DIAGNOSIS; THERAPY; FAILURE; SEPSIS; BURDEN; SCORE;
D O I
10.1371/journal.pone.0200504
中图分类号
O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];
学科分类号
07 ; 0710 ; 09 ;
摘要
Background There is only limited information on mortality over extended periods in hospitalized patients with pneumococcal community-acquired pneumonia (CAP). We aimed to evaluate the 30-day mortality and whether is changed over a 20-year period among immunocompetent adults hospitalized with pneumococcal CAP. Methods We conducted a retrospective observational study of data that were prospectively collected at the Hospital Clinic of Barcelona of all adult patients hospitalized with diagnosis of pneumococcal CAP over a 20-year period. To aid analysis, results were divided into four periods of 5 years each (1997-2001, 2002-2006, 2007-2011, 2012-2016). The primary outcome was 30-day mortality, but secondary outcomes included intensive care unit (ICU) admission, lengths of hospital and ICU-stays, ICU-mortality, and need of mechanical ventilation. Results From a cohort of 6,403 patients with CAP, we analyzed the data for 1,120 (17%) adults with a diagnosis of pneumococcal CAP. Over time, we observed decreases in the rates of alcohol consumption, smoking, influenza vaccination, and older patients (age >65 years), but increases in admissions to ICU and the need for non-invasive mechanical ventilation. The overall 30-day mortality rate was 8% (95% confidence interval, 6%-9%; 84 of 1,120 patients) and did not change significantly between periods (p = 0.33). Although, we observed a decrease in ICU-mortality comparing the first period (26%) to the second one (10%), statistical differences disappeared with adjustment (p0.38). Conclusion Over time, 30-day mortality of hospitalized pneumococcal CAP did not change significantly. Nor did it change in the propensity-adjusted multivariable analysis. Since mortality in pneumococcal pneumonia has remained unaltered for many years despite the availability of antimicrobial agents with proven in vitro activity, other non-antibiotic strategies should be investigated.
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页数:16
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