SEVERE COMMUNITY-ACQUIRED PNEUMOCOCCAL PNEUMONIA

Streptococcus pneumoniae is the most frequent pathogen of severe commu nity-acquired pneumonia (CAP) necessitating hospitalization. The main objective of this multicentre prospective study was to determine the v alue of clinical, biological, and radiological features for predicting pneumococcal etiology and to define prognostic factors. Streptococcus pneumoniae was isolated in 43/132 patients (33%) with CAP requiring I CU treatment. The mean age of the patients with pneumococcal pneumonia was 55 +/- 17 (SD) yrs and 34 were male. On admission, 14 patients wi th pneumococcal pneumonia were in shock, 24 were mentally confused, an d 27 required mechanical ventilation during their hospitalization. Amo ng the clinical, biological, and radiological features, fever >39 degr ees C, pleuritic chest pain, lobar distribution or alveolar consolidat ion, and an increase in immature granulocytes greater than or equal to 5% of WBC were more frequent in pneumococcal pneumonia than in other etiologies. Mortality was 35%. Fatal outcome was significantly related to the presence of impaired alertness, septic shock, mechanical venti lation, acute renal failure, and bacteremic pneumonia.