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Risk factors for respiratory failure in pneumococcal pneumonia: the importance of pneumococcal serotypes

Joaquín Burgos, Manel Luján, Maria Nieves Larrosa, Dionísia Fontanals, Guadalupe Bermudo, Ana Maria Planes, Mireia Puig, Jordi Rello, Vicenç Falcó, Albert Pahissa
European Respiratory Journal 2014 43: 545-553; DOI: 10.1183/09031936.00050413
Joaquín Burgos
1Dept of Infectious Diseases, Hospital Universitari Vall d’Hebron, Vall d’Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona
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  • For correspondence: jburgos@vhebron.net
Manel Luján
2Dept of Pneumology, Hospital de Sabadell, Corporació Sanitaria Parc Taulí, Universitat Autònoma de Barcelona, Barcelona
3CIBER Enfermedades Respiratorias (CIBERES), Barcelona
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Maria Nieves Larrosa
4Dept of Microbiology, Hospital Universitari Vall d’Hebron, Vall d’Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona
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Dionísia Fontanals
5Dept of Microbiology, UDIAT, Hospital de Sabadell, Corporació Sanitaria Parc Taulí, Universitat Autònoma de Barcelona, Barcelona
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Guadalupe Bermudo
2Dept of Pneumology, Hospital de Sabadell, Corporació Sanitaria Parc Taulí, Universitat Autònoma de Barcelona, Barcelona
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Ana Maria Planes
3CIBER Enfermedades Respiratorias (CIBERES), Barcelona
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Mireia Puig
1Dept of Infectious Diseases, Hospital Universitari Vall d’Hebron, Vall d’Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona
6Spanish Network for Research in Infectious Diseases (REIPI), Seville
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Jordi Rello
3CIBER Enfermedades Respiratorias (CIBERES), Barcelona
7Dept of Critical Care, Hospital Universitari Vall d’Hebron, Vall d’Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
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Vicenç Falcó
1Dept of Infectious Diseases, Hospital Universitari Vall d’Hebron, Vall d’Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona
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Albert Pahissa
1Dept of Infectious Diseases, Hospital Universitari Vall d’Hebron, Vall d’Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona
6Spanish Network for Research in Infectious Diseases (REIPI), Seville
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Abstract

Pneumococcal serotypes are one of the main determinants of pneumococcal disease severity; however, data about their implication in respiratory failure are scarce.

We conducted an observational study of adults hospitalised with invasive pneumococcal pneumonia to describe the host- and pathogen-related factors associated with respiratory failure.

Of 1258 adults with invasive pneumococcal disease, 615 (48.9%) had respiratory failure at presentation. Patients with respiratory failure were older (62.1 years versus 55.4 years, p<0.001) and had a greater proportion of comorbid conditions. They also had a greater proportion of septic shock (41.7% versus 6.1%, p<0.001), required admission to the intensive care unit more often (38.4% versus 4.2%, p<0.001) and had a higher mortality (25.5% versus 3.5%, p<0.001). After adjustment, independent risk factors for respiratory failure were: age >50 years (OR 1.63, 95% CI 1.15–2.3), chronic lung disease (OR 1.54, 95% CI 1.1–2.15), chronic heart disease (OR 1.49, 95% CI 1.01–2.22) and infection caused by serotypes 3 (OR 1.97, 95% CI 1.23–3.16), 19A (OR 2.34, 95% CI 1.14–4.42) and 19F (OR 3.55, 95% CI 1.22–10.28).

In conclusion, respiratory failure is a frequent complication of pneumococcal pneumonia and causes high morbidity and mortality. Pneumococcal serotypes 3, 19A and 19F are the main risk factors for this complication.

Abstract

Respiratory failure in invasive pneumonia is determined by older age, comorbidities and serotypes 3, 19A and 19F http://ow.ly/qHN6D

Footnotes

  • Earn CME accreditation by answering questions about this article. You will find these at the back of the printed copy of this issue or online at www.erj.ersjournals.com/site/misc/cmeinfo.xhtml

  • For editorial comments see page 331.

  • Support statement: This work was institutionally supported by the Spanish Network for Research in Infectious Diseases (REIPI), RD06/008 from the Ministry of Science and Innovation, “Instituto de Salud Carlos III” and Centro de Investigación Biomédica en Red (CIBER) de Enfermedades Respiratorias (grant number 06/06/36).

  • Conflict of interest: None declared.

  • Received March 20, 2013.
  • Accepted June 28, 2013.
  • ©ERS 2014
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Risk factors for respiratory failure in pneumococcal pneumonia: the importance of pneumococcal serotypes
Joaquín Burgos, Manel Luján, Maria Nieves Larrosa, Dionísia Fontanals, Guadalupe Bermudo, Ana Maria Planes, Mireia Puig, Jordi Rello, Vicenç Falcó, Albert Pahissa
European Respiratory Journal Feb 2014, 43 (2) 545-553; DOI: 10.1183/09031936.00050413

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Risk factors for respiratory failure in pneumococcal pneumonia: the importance of pneumococcal serotypes
Joaquín Burgos, Manel Luján, Maria Nieves Larrosa, Dionísia Fontanals, Guadalupe Bermudo, Ana Maria Planes, Mireia Puig, Jordi Rello, Vicenç Falcó, Albert Pahissa
European Respiratory Journal Feb 2014, 43 (2) 545-553; DOI: 10.1183/09031936.00050413
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