tetano
Editor, Senior Moderator
PLoS One. 2018 Jul 18;13(7):e0200504. doi: 10.1371/journal.pone.0200504. eCollection 2018.
[h=1]Twenty-year trend in mortality among hospitalized patients with pneumococcal community-acquired pneumonia.[/h] Cill?niz C[SUP]1[/SUP], Liapikou A[SUP]2[/SUP], Martin-Loeches I[SUP]3[/SUP], Garc?a-Vidal C[SUP]4[/SUP], Gabarr?s A[SUP]1[/SUP], Ceccato A[SUP]1[/SUP], Magdaleno D[SUP]5[/SUP], Mensa J[SUP]4[/SUP], Marco F[SUP]6[/SUP], Torres A[SUP]1[/SUP].
[h=3]Author information[/h]
[h=3]Abstract[/h] [h=4]BACKGROUND:[/h] 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.
[h=4]METHODS:[/h] 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.
[h=4]RESULTS:[/h] 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).
[h=4]CONCLUSION:[/h] 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.
PMID: 30020995 DOI: 10.1371/journal.pone.0200504
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[h=1]Twenty-year trend in mortality among hospitalized patients with pneumococcal community-acquired pneumonia.[/h] Cill?niz C[SUP]1[/SUP], Liapikou A[SUP]2[/SUP], Martin-Loeches I[SUP]3[/SUP], Garc?a-Vidal C[SUP]4[/SUP], Gabarr?s A[SUP]1[/SUP], Ceccato A[SUP]1[/SUP], Magdaleno D[SUP]5[/SUP], Mensa J[SUP]4[/SUP], Marco F[SUP]6[/SUP], Torres A[SUP]1[/SUP].
[h=3]Author information[/h]
[h=3]Abstract[/h] [h=4]BACKGROUND:[/h] 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.
[h=4]METHODS:[/h] 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.
[h=4]RESULTS:[/h] 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).
[h=4]CONCLUSION:[/h] 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.
PMID: 30020995 DOI: 10.1371/journal.pone.0200504
Free full text