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Bacteraemic and non-bacteraemic/urinary antigen-positive pneumococcal community-acquired pneumonia compared

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Abstract

The diagnosis of invasive pneumococcal pneumonia is based mainly on bacteraemia. Episodes without bacteraemia, but with a positive urinary antigen test (UAT), are considered non-invasive. We determined differences in outcome between patients with bacteraemic and non-bacteraemic/UAT-positive pneumococcal community-acquired pneumonia (CAP). Adult patients with clinical and radiological evidence of CAP with blood cultures and UAT tests performed at presentation in three Dutch laboratories between June 2008 and May 2010 were included. Clinical characteristics were retrospectively extracted from hospital records. Overall, 168 patients had non-bacteraemic/UAT-positive pneumococcal CAP and 123 had bacteraemic pneumococcal CAP. The day-30 mortality was 9 % and 13 % for non-bacteraemic/UAT-positive and bacteraemic pneumococcal CAP patients, respectively [risk difference −4 %, 95 % confidence interval (CI) −11 % to +3 %, p = 0.28]. In a multivariable logistic regression model, age ≥65 years, admission to the intensive care unit/coronary care unit (ICU/CCU) and presence of an immunocompromising condition were associated with day-30 mortality. A non-significant association with mortality was found for bacteraemia [odds ratio (OR) 2.21, 95 % CI 0.94–5.21, p = 0.07). No such trend was found for UAT positivity. The median lengths of hospital stay were 8 [interquartile range (IQR) 5–14] and 10 (IQR 6–18) days for non-bacteraemic/UAT-positive and bacteraemic pneumococcal CAP patients, respectively (p = 0.05). As compared to non-bacteraemic/UAT-positive pneumococcal CAP, bacteraemic pneumococcal CAP has a stronger association with day-30 mortality.

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Acknowledgements

We would like to thank the medical students, participating laboratories and hospitals for making the data collection possible.

Funding

This study was supported, in part, by an unrestricted research grant from Pfizer Pharmaceuticals. The sponsor played no role in the study design, data analyses, and preparation, review or approval of the manuscript.

Conflict of interest

The authors declare that they have no conflict of interest with regard to the submitted work.

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Authors and Affiliations

  1. Department of Medical Microbiology and Immunology, St. Antonius Hospital, P.O. Box 2500, 3430 EM, Nieuwegein, The Netherlands

    S. P. van Mens & B. J. M. Vlaminckx

  2. Medical Microbiology, University Medical Center Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands

    S. P. van Mens & M. J. M. Bonten

  3. Linnaeus Institute, P.O. Box 770, 2130 AT, Hoofddorp, The Netherlands

    A. M. M. van Deursen

  4. Paediatric Immunology and Infectious Diseases, Wilhelmina Children’s Hospital, P.O. Box 85090, 3508 AB, Utrecht, The Netherlands

    A. M. M. van Deursen & E. A. M. Sanders

  5. National Institute for Public Health and the Environment, P.O. Box 1, 3720 BA, Bilthoven, The Netherlands

    S. C. de Greeff, H. E. de Melker & L. M. Schouls

  6. Medical Microbiology, Academic Medical Center Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands

    A. van der Ende

  7. Netherlands Reference Laboratory for Bacterial Meningitis, Academic Medical Center Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands

    A. van der Ende

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  1. S. P. van Mens
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  2. A. M. M. van Deursen
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  3. S. C. de Greeff
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  4. H. E. de Melker
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  5. L. M. Schouls
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  6. A. van der Ende
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  7. M. J. M. Bonten
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  8. E. A. M. Sanders
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  9. B. J. M. Vlaminckx
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Correspondence to S. P. van Mens.

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van Mens, S.P., van Deursen, A.M.M., de Greeff, S.C. et al. Bacteraemic and non-bacteraemic/urinary antigen-positive pneumococcal community-acquired pneumonia compared. Eur J Clin Microbiol Infect Dis 34, 115–122 (2015). https://doi.org/10.1007/s10096-014-2209-5

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  • DOI: https://doi.org/10.1007/s10096-014-2209-5

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