Clinical presentation, processes and outcomes of care for patients with pneumococcal pneumonia

OBJECTIVE: To describe the presentation, resolution of symptoms, processes of care, and outcomes of pneumococcal pneumonia, and to compare features of the bacteremic and nonbacteremic forms of this illness. DESIGN:A prospective cohort study, SETTING: Five medical institutions in 3 geographic locations. PARTICIPANTS: Inpatients and outpatients with community-acquired pneumonia (CAP), MEASUREMENTS: Sociodemographic characteristics, respiratory and nonrespirat ory symptoms, and physical examination findings were obtained from intervie ws or chart review. Severity of illness was assessed using a validated pred iction rule for short-term mortality in CAP, Pneumococcal pneumonia was cat egorized as bacteremic; nonbacteremic, pure etiology; or nonbacteremic, mix ed etiology, MAIN RESULTS: One hundred fifty-eight (6.9%) of 2,287 patients (944 outpati ents, 1,343 inpatients) with CAP had pneumococcal pneumonia. Sixty-five (41 %) of the 158 with pneumococcal pneumonia were bacteremic: 74 (47%) were no nbacteremic with S, pneumoniae as sole pathogen: and 19 (12%) were nonbacte remic with S. pneumoniae as one of multiple pathogens. The pneumococcal bac teremia sate for outpatients was 2.6% and for inpatients it was 6.6%. Cough , dyspnea, and pleuritic pain were common respiratory symptoms. Hemopytsis occurred in 16% to 22% of the patients. A large number of nonrespiratory sy mptoms were noted. Bacteremic patients were less likely than nonbacteremic patients to have sputum production and myalgias (60% vs 82% and 33% vs 57%, respectively; P < .01 for both), more likely to have elevated blood urea n itrogen and serum creatinine levels, and more Likely to receive pencillin t herapy. Half of bacteremic patients were in the low risk category for short -term mortality (groups I to III), similar to the nonbacteremic patients. N one of the 32 bacteremic patients in risk groups I to III died, while 7 of 23 (30%) in risk group V died, Intensive care unit admissions and pneumonia -related mortality were similar between bacteremic and nonbacteremic groups . although 46% of the bacteremic group had respiratory failure compared wit h 32% and 37% for the other groups. The nonbacteremic pure etiology patient s returned to household activities faster than bacteremic patients. Symptom s frequently persisted at 30 days: cough (50%); dyspnea (53%): sputum produ ction (48%); pleuritic pain (13%); and fatigue (63%). CONCLUSIONS: There were few differences in the presentation of bacteremic a nd nonbacteremic pneumococcal pneumonia, About half of bacteremic pneumococ cal pneumonia patients were at low risk for mortality. Symptom resolution f requently was slow.