Estimating the risk of bacteraemia in hospitalised patients with pneumococcal pneumonia.

Leyre Serrano, Luis Alberto Ruiz, Silvia Pérez, Pedro Pablo España, Ainhoa Gomez, Catia Cilloniz, Ane Uranga, Antoni Torres, Rafael Zalacain

Journal: The Journal of infection 2022;85(6):644-651

PMID: 36154852

Full Text on Elsevier Science View on PubMed

Abstract

OBJECTIVE

To construct a prediction model for bacteraemia in patients with pneumococcal community-acquired pneumonia (P-CAP) based on variables easily obtained at hospital admission.

METHODS

This prospective observational multicentre derivation-validation study was conducted in patients hospitalised with P-CAP between 2000 and 2020. All cases were diagnosed based on positive urinary antigen tests in the emergency department and had blood cultures taken on admission. A risk score to predict bacteraemia was developed.

RESULTS

We included 1783 patients with P-CAP (1195 in the derivation and 588 in the validation cohort). A third (33.3%) of the patients had bacteraemia. In the multivariate analysis, the following were identified as independent factors associated with bacteraemia: no influenza vaccination the last year, no pneumococcal vaccination in the last 5 years, blood urea nitrogen (BUN) ≥30 mg/dL, sodium <130 mmol/L, lymphocyte count <800/µl, C-reactive protein ≥200 mg/L, respiratory failure, pleural effusion and no antibiotic treatment before admission. The score yielded good discrimination (AUC 0.732; 95% CI: 0.695-0.769) and calibration (Hosmer-Lemeshow p-value 0.801), with similar performance in the validation cohort (AUC 0.764; 95% CI:0.719-0.809).

CONCLUSIONS

We found nine predictive factors easily obtained on hospital admission that could help achieve early identification of bacteraemia. The prediction model provides a useful tool to guide diagnostic decisions.

Address: Pneumology Service, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain; Department of Immunology, Microbiology and Parasitology. Facultad de Medicina y Enfermería, Universidad del País Vasco/Euskal Herriko Unibertsitatea UPV/EHU, Leioa, Bizkaia, Spain; Biocruces Bizkaia Health Research Institute, Barakaldo. Bizkaia, Spain. Electronic address: [email protected].; Pneumology Service, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain; Department of Immunology, Microbiology and Parasitology. Facultad de Medicina y Enfermería, Universidad del País Vasco/Euskal Herriko Unibertsitatea UPV/EHU, Leioa, Bizkaia, Spain; Biocruces Bizkaia Health Research Institute, Barakaldo. Bizkaia, Spain. Electronic address: [email protected].; Bioinformatics and Statistics Unit, Biocruces Bizkaia Health Research Institute, Barakaldo. Bizkaia, Spain. Electronic address: [email protected].; Pneumology Service, Hospital Universitario Galdakao-Usansolo, Galdakao, Bizkaia, Spain. Electronic address: [email protected].; Pneumology Service, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain; Biocruces Bizkaia Health Research Institute, Barakaldo. Bizkaia, Spain. Electronic address: [email protected].; Pneumology Service, Hospital Clinic. Institut D´Investigacions Biomediques August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona Spain; Faculty of Health Sciences, Continental University, Huancayo, Peru. Electronic address: [email protected].; Pneumology Service, Hospital Universitario Galdakao-Usansolo, Galdakao, Bizkaia, Spain. Electronic address: [email protected].; Pneumology Service, Hospital Clinic. Institut D´Investigacions Biomediques August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona Spain. Electronic address: [email protected].; Pneumology Service, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain; Biocruces Bizkaia Health Research Institute, Barakaldo. Bizkaia, Spain. Electronic address: [email protected].

DOI: 10.1016/j.jinf.2022.09.017

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MeSH Terms: Humans, Pneumonia, Pneumococcal, Bacteremia, Blood Culture, Streptococcus pneumoniae, Hospitalization