Prospective study of prognostic factors in community-acquired bacteremic pneumococcal disease in 5 countries

To define the influence of prognostic factors in patients with community-ac quired pneumococcal bacteremia, a 2-year prospective study was performed in 5 centers in Canada, the United States, the United Kingdom, Spain, and Swe den. By multivariate analysis, the independent predictors of death among th e 460 patients were age >65 years (odds ratio [OR], 2.2), living in a nursi ng home (OR, 2.8), presence of chronic pulmonary disease (OR, 2.5), high ac ute physiology score (OR for scores 9-14, 7.6; for scores 15-17, 22; and fo r scores >17, 41), and need for mechanical ventilation (OR, 4.4). Of patien ts with meningitis, 26% died. Of patients with pneumonia without meningitis , 19% of those with greater than or equal to 2 lobes and 7% of those with o nly 1 lobe involved (P = .0016) died. The case-fatality rate differed signi ficantly among the centers: 20% in the United States and Spain, 13% in the United Kingdom, 8% in Sweden, and 6% in Canada. Differences of disease seve rity and of frequencies and impact of underlying chronic conditions were fa ctors of probable importance for different outcomes.