Low C-reactive protein values at admission predict mortality in patients with severe community-acquired pneumonia caused by Streptococcus pneumoniae that require intensive care management

Abstract Background Severe community-acquired pneumonia (SCAP) caused by human adenovirus type 7 (HAdV-7) in immunocompetent adults has been of increasing concern recently. Clinical understanding of SCAP caused by HAdV-7 in adults remains limited, though the pathogen has been adequately identified by metagenomic next-generation sequencing (mNGS). Methods We conducted a retrospective review of all patients with SCAP caused by HAdV-7 in immunocompetent adults admitted to Nanjing Drum Tower Hospital, a tertiary hospital in Nanjing, China, between July 2017 and April 2020. Clinical manifestation, laboratory findings, serial radiological characteristics, mNGS results, treatments and outcomes of these patients were collected and analyzed. Results A total of 7 SCAP patients with confirmed HAdV-7 infections were included. All patients were positive for HAdV-7 DNA fragments by mNGS for BALF and blood specimens. The median of the identified reads of two groups were 2783 and 1038, and the median coverage rates were 99.3% and 97.7%, respectively. All the patients were male and the median age was 23 years. High fever (100%), cough (57.14%) and dyspnea (100%) were the most frequent symptoms at admission. Laboratory data showed slightly decreased leucocytes but high procalcitonin and C-reactive protein levels. At early stage, with median 5 days from onset of illness, consolidation (85.71%) and patchy ground-glass opacity (GGOs) (85.71%) in unilateral lung were the most common findings in severe HAdV CAP. Within median 8 days after illness onset into progressive stage, consolidation developed and was the predominant finding in all patients, and 6 patients (85.71%) showed bilateral consolidations. In convalescent stage with median 18 days after illness onset, the parenchymal abnormalities began to absorb. Conclusions MNGS of blood or BALF could identify HAdV-7 infection accurately. Doctors should be aware of SCAP caused by HAdV-7 infection and perform mNGS as soon as possible when patients had persistent high fever, cough,decreased WBC༌high C-reactive protein and consolidation and GGO in unilateral or bilateral lungs shown by chest CT scan.

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A Peculiar Case of Invasive Streptococcus pneumoniae

Case Reports in Infectious Diseases ◽

10.1155/2017/1530507 ◽

2017 ◽

Vol 2017 ◽

pp. 1-3

Author(s):

Adeel Rafi Ahmed ◽

Liam Townsend ◽

Helen Tuite ◽

Catherine Fleming

Keyword(s):

Intensive Care Unit ◽

Emergency Department ◽

Intensive Care ◽

Streptococcus Pneumoniae ◽

Respiratory Distress ◽

Multiorgan Failure ◽

Community Acquired Pneumonia ◽

Icu Admission ◽

Severe Community Acquired Pneumonia ◽

Peculiar Case

Patients commonly present to the emergency department with acute respiratory distress; however, the differentials are broad and at times difficult to distinguish. We describe a case of severe community-acquired pneumonia (CAP) secondary to invasive Streptococcus pneumoniae. The patient was intubated within 3 h of presentation and suffered multiorgan failure within 72 h of intensive care unit (ICU) admission. This case is a stark illustration of how the most common bacteria associated with CAP can be fatal and highlights the associated markers of severity. It also outlines other potential complications including a very rare phenomenon of cardiomyopathy with myocarditis associated with S. pneumoniae bacteraemia.

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Bacteraemia and antibiotic-resistant pathogens in community acquired pneumonia: risk and prognosis

European Respiratory Journal ◽

10.1183/09031936.00152514 ◽

2015 ◽

Vol 45 (5) ◽

pp. 1353-1363 ◽

Cited By ~ 25

Author(s):

Antoni Torres ◽

Catia Cillóniz ◽

Miquel Ferrer ◽

Albert Gabarrús ◽

Eva Polverino ◽

...

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Multivariate Analysis ◽

Intensive Care ◽

Community Acquired Pneumonia ◽

Blood Cultures ◽

Arterial Oxygen ◽

C Reactive Protein ◽

Antibiotic Resistant ◽

Reactive Protein

The sensitivity of blood cultures in the diagnosis of bacteraemia for community-acquired pneumonia is low. Recommendations, by guidelines, to perform blood cultures are discordant. We aimed to determine the incidence, microbial aetiology, risk factors and outcomes of bacteraemic patients with community-acquired pneumonia, including cases with antibiotic-resistant pathogens (ARP).A prospective, observational study was undertaken on consecutive adult patients admitted to the Hospital Clinic of Barcelona (Barcelona, Spain) with community-acquired pneumonia and blood cultures were obtained.Of the 2892 patients included, bacteraemia was present in 297 (10%) patients; 30 (10%) of whom had ARP (multidrug-resistantStreptococcus pneumoniae, methicillin-resistantStaphylococcus aureus,Pseudomonas aeruginosa, and an extended spectrum of beta-lactamase producingEnterobacteriaceae). In multivariate analyses, pleuritic pain, C-reactive protein ≥21.6 mg·dL−1and intensive care unit admissions were independently associated with bacteraemia, while prior antibiotic treatment and pneumococcal vaccine were protective factors. The risk factors for ARP bacteraemia were previous antibiotics and C-reactive protein <22.2 mg·dL−1, while pleuritic pain was the only protective factor in the multivariate analysis. Bacteraemia (excluding ARP), appropriate empiric treatment, neurological disease, arterial oxygen tension/inspiratory oxygen fraction <250, pneumonia severity index risk classes IV and V, and intensive care unit admission were independently associated with a 30-day hospital mortality in the multivariate analysis. Inappropriate therapy was more frequent in ARP bacteraemia, compared with other bacteraemias (27%versus3%, respectively, p<0.001).Antibiotic therapy protected against bacteraemia, but increased specifically the risk of bacteraemia from ARP due to the inappropriate coverage of these pathogens. Identifying patients at risk of ARP bacteraemia would help in deciding appropriate empiric antimicrobial therapy. The results from this study provide evidence concerning community-acquired pneumonia patients in whom blood cultures should not be performed.

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