Early predictors of mortality in pneumococcal bacteraemia

Area of Science:

• Infectious Diseases
• Critical Care Medicine
• Epidemiology

Background:

• Pneumococcal bacteraemia has a significant mortality rate, with many deaths occurring within 48 hours of admission.
• Early identification of critically ill patients is crucial for timely and effective management to influence outcomes.

Purpose of the Study:

• To develop an evidence-based assessment for clinicians to rapidly identify patients with pneumococcal bacteraemia at high risk of mortality.
• To identify independent predictors of case fatality in pneumococcal bacteraemia to guide early management strategies.

Main Methods:

• Retrospective data collection from medical records, including history, physical examination, radiological, and laboratory findings.
• Statistical analysis using Pearson's Chi-squared test and stepwise logistic regression to identify significant predictors of case fatality (P < 0.05).

Main Results:

• Overall case fatality was 21%. Independent predictors of higher case fatality included older age, acidosis, and elevated serum alanine aminotransferase (ALT).
• Serotype 14 was the most common and associated with higher fatality. Colder weather correlated with increased incidence and fatality.
• Patients receiving intensive therapy (ITU) had a 44% case fatality rate, and less than 50% of deceased patients received ITU management.

Conclusions:

• Despite advances in antibiotics and vaccines, pneumococcal bacteraemia mortality remains high.
• Clinical parameters identified can facilitate early risk stratification, potentially improving patient outcomes.
• Vaccination strategies, particularly for the elderly, may reduce incidence and mortality; further research on intensive therapy's impact is needed.