Chest
Original ResearchCommunity-Acquired PneumoniaSeverity of Pneumococcal Pneumonia Associated With Genomic Bacterial Load
Section snippets
Study Design
This was a prospective study of adult patients hospitalized with CAP. Data and blood samples were collected in the ED. Data were entered into an electronic database for analysis. Patients were observed for the development of the predefined end points of septic shock development and the need for MV from the time they were admitted to the ED until they were discharged from the hospital. Secondary outcomes were the development of AKI and ARDS, and in-hospital mortality.
Study Population
Adult patients admitted to
Study Population
A total of 353 white patients with CAP were included in the study, of whom 93 were documented as a having a diagnosis of definite CAP (n = 44) or probable CAP (n = 49) caused by S pneumoniae, and 260 patients had no evidence of S pneumoniae and a negative rt-PCR result. A description of the techniques used to detect S pneumoniae is shown in Table A1 (in the online supplemental material). Clinical characteristics of the 260 patients with negative bacterial load and no evidence of S pneumoniae
Discussion
This study confirms the association between a high quantitative bacterial genomic load of S pneumoniae in blood samples and increased mortality. It also reveals an association between bacterial load and the development of septic shock or the need for MV. The implication of these findings is that a sample obtained for bacterial load measurement will provide valuable prognostic information. Our observations also reveal some insight into the mechanisms that underlie the risk factors associated
Acknowledgments
Author contributions: Drs. Rello and Lisboa were responsible for analysis of data and writing the first draft of the article; all remaining authors contributed scientifically to the final version of the article. Drs. Rello, Gallego, Lujan, Lopez, and Lisboa enrolled patients, recorded variables, conducted the follow-up, and collected samples. Drs. Waterer and Kee, and Mr. Kay were responsible for performing the quantitative reverse transcription PCR assay.
Financial/nonfinancial disclosures: The
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Funding/Support: This study was funded by FIS 04/1500, Fondo de Investigaciones Sanitarias, CIBER Enfermedades Respiratorias (CIBERes 06/06/0036), and AGAUR (2005/SGR/920). Dr. Waterer is supported by the National Health and Medical Research Council of Australia.
Presented in part at the 2008 American Thoracic Society Conference, Toronto, ON, Canada.
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).