Clinical Characteristics and Outcome of Adults with Community-acquired Pneumonia Caused by Penicillin-susceptible and Penicillin-nonsusceptible Streptococcus pneumoniae

青黴素感受性和青黴素非感受性肺炎雙球菌所引起之社區性肺炎的臨床特徵和預後

林偉傑(Wei-Chieh Lin) ； 陳炯睿(Chiung-Zuei Chen) ； 朱遠志(Yuan-Chih Chu) ； 李政宏(Cheng-Hung Lee) ； 陳昌文(Chang-Wen Chen) ； 張漢煜(Han-Yu Chang) ； 薛尊仁(Tzuen-Ren Hsiue)

《胸腔醫學》 20卷4期 (2005/08) Pp. 260-269

https://doi.org/10.29806/TM.200508.0002

摘要

Study objectives: To compare the clinical characteristics and medical outcomes of adult patients with pneumonia caused by penicillin-susceptible (PSSP) and penicillin-nonsusceptible streptococcus pneumoniae (PNSSP), and to identify the predictive factors for an adverse outcome in these patients.
Patients and methods: Adult patients with community-acquired pneumococcal pneumonia, who were diagnosed during a 3-year period from January 1, 1999 to December 31, 2001, were enrolled, and their clinical and radiographic features were analyzed. A multivariate logistic regression model was used, with variables that were significantly associated with an adverse outcome in the univariate analysis.
Results: Of the 45 patients enrolled, 29 (64%) had pneumonia caused by PNSSP, and the remaining 16 (36%) had pneumonia caused by PSSP. Underlying heart disease was more common in the PSSP (38%) than the PNSSP patients (7%) (p=0.017). The overall mortality rate was 11% (5 of 45), with most deaths occurring within 4 days after the initiation of antibiotic therapy. There were no statistically significant differences in the frequency of bacteremia, in-hospital complications, and mortality between the PSSP and PNSSP groups. The durations of fever and the length of ICU and hospital stay were also similar in the 2 groups. Univariate analysis showed that the patients who had an adverse outcome were more likely to have had the initial presentations of dyspnea (p=0.020), an altered mental status (p=0.036), an initial systolic blood pressure ＜100 mmHg (p=0.036), leukopenia (p=0.036), initial radiographic findings of multiple lobal involvement (p=0.011), an initial arterial blood pH＜7.35 (p=0.001), or a PaO2/FiO2 ratio ＜250 (p=0.005), than patients without adverse outcomes. Multiple logistic regression analysis demonstrated that a PaO2/FiO2 ratio ＜250 was the only independent predictive factor related to an adverse outcome.
Conclusions: Our study suggests that the clinical presentation and outcome of therapy did not differ significantly between the patients with pneumonia caused by either PSSP or PNSSP. A PaO2/FiO2 ＜250 was the only independent predictive factor related to the adverse outcome of community-acquired pneumococcal pneumonia.

關鍵字

肺炎雙球菌 ； 肺炎 ； 青黴素感受性 ； 預後

並列摘要

Study objectives: To compare the clinical characteristics and medical outcomes of adult patients with pneumonia caused by penicillin-susceptible (PSSP) and penicillin-nonsusceptible streptococcus pneumoniae (PNSSP), and to identify the predictive factors for an adverse outcome in these patients.
Patients and methods: Adult patients with community-acquired pneumococcal pneumonia, who were diagnosed during a 3-year period from January 1, 1999 to December 31, 2001, were enrolled, and their clinical and radiographic features were analyzed. A multivariate logistic regression model was used, with variables that were significantly associated with an adverse outcome in the univariate analysis.
Results: Of the 45 patients enrolled, 29 (64%) had pneumonia caused by PNSSP, and the remaining 16 (36%) had pneumonia caused by PSSP. Underlying heart disease was more common in the PSSP (38%) than the PNSSP patients (7%) (p=0.017). The overall mortality rate was 11% (5 of 45), with most deaths occurring within 4 days after the initiation of antibiotic therapy. There were no statistically significant differences in the frequency of bacteremia, in-hospital complications, and mortality between the PSSP and PNSSP groups. The durations of fever and the length of ICU and hospital stay were also similar in the 2 groups. Univariate analysis showed that the patients who had an adverse outcome were more likely to have had the initial presentations of dyspnea (p=0.020), an altered mental status (p=0.036), an initial systolic blood pressure ＜100 mmHg (p=0.036), leukopenia (p=0.036), initial radiographic findings of multiple lobal involvement (p=0.011), an initial arterial blood pH＜7.35 (p=0.001), or a PaO2/FiO2 ratio ＜250 (p=0.005), than patients without adverse outcomes. Multiple logistic regression analysis demonstrated that a PaO2/FiO2 ratio ＜250 was the only independent predictive factor related to an adverse outcome.
Conclusions: Our study suggests that the clinical presentation and outcome of therapy did not differ significantly between the patients with pneumonia caused by either PSSP or PNSSP. A PaO2/FiO2 ＜250 was the only independent predictive factor related to the adverse outcome of community-acquired pneumococcal pneumonia.

並列關鍵字

streptococcus pneumoniae ； pneumonia ； penicillin-susceptibility ； outcomes