Influence of comorbidity and severity on the clinical outcome of bacteremic pneumococcal pneumonia treated with beta-lactam monotherapy

The influence of the severity of pneumonia and comorbidity factors, as pred ictors of clinical outcome, was assessed in patients with microbiologically documented pneumococcal bacteremic pneumonia treated with penicillin or th ird generation cephalosporin monotherapy in a 5-year retrospective study. A mong 288 patients admitted to three Spanish hospitals with bacteremic pneum ococcal pneumonia, 65 (23%) were included. Twenty-four were treated with pe nicillins and 41 with a third-generation cephalosporin, Twenty-seven patien ts (42%) had severe pneumonia and 41 (63%) had a comorbidity index greater than or equal to 1, Twenty-one patients (32%) were infected with penicillin -resistant strains, Four cases (2 with penicillin-resistant strains; 3 trea ted with cephalosporins) were clinical failures. Four cases (3 with penicil lin-resistant strains; 2 treated with cephalosporins) died, i.e, 6% mortali ty rate. The only factor that influenced empirical treatment election was H IV-positive condition. Clinical outcome was not influenced by treatment ele ction, penicillin susceptibility of the infecting pneumococci, patient basa l conditions or severity of pneumonia, but the latter was associated with m ortality and length of hospitalization.