A Retrospective Study of Fulminant‐Type Pneumococcal Sepsis in a Tertiary Care Emergency Community Hospital in Japan

Background:

Pneumococcal infection accounts for many cases of community‐acquired pneumonia. Patients with pneumococcal bacteremia (PB) are at risk for developing sepsis, severe sepsis or septic shock. Moreover, patients with post‐splenectomy, congenital asplenia or hyposplenia are known to have greater risk for developing fulminant infection. However, few studies have been conducted concerning clinical features of fulminant‐type pneumococcal pneumonia in adult patients who have not undergone splenectomy. Thus the current study was aimed to characterize rapidly fatal adult patients with PB and no prior splenectomy in Shonan Kamamura General Hospital, a tertiary care community medical center with emergency department in Japan.

Methods:

We retrospectively analyzed 57 patients with positive blood cultures for Streptococcus pneumoniae from April 2006 to December 2010, inclusive. Two groups were reviewed as follows: Group A (n=11) consisted of patients who died within two days after hospital admission. Group B (n=46) consisted of patients who survived more than two days after admission. We collected data about age, gender, vital signs, pulse oximetry oxygen saturation, pre‐existing diseases (diabetes mellitus, liver disease, malignancy, hematologic disease, and autoimmune disease), presence of pneumonia, acidosis, required mechanical ventilation, blood chemistry values, and SOFA and CURB‐65 score.

Results:

There were 77% and 79% of pneumonia in the groups A and B, respectively. There were no significant differences in pre‐existing diseases between the two groups. Compared to the group B, patients in group A showed significantly lower systolic blood pressures (P=0.04), lower blood pH (P=0.004), higher levels of alanine transaminase (p=0.006), blood urea nitrogen (p=0.01) and potassium (p=0.02), lower level of albumin (p=0.03), and peripheral leukocyte count (P=0.04), and CURB‐65 scores (P<0.001).

Conclusions:

Elevated levels of alanine transaminase and blood urea nitrogen as well as low level of serum albumin may be useful as potential predictors of early mortality in patients with PB. CURB‐65 score can also be used for evaluating the severity of pneumococcal sepsis.