Diabetes was the only comorbid condition associated with mortality of invasive pneumococcal infection in ICU patients: a multicenter observational study from the Outcomerea research group
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Streptococcus pneumoniae is a leading pathogen of severe community, hospital or nursing facility infections. We sought to describe characteristics of invasive pneumococcal infection (IPI) and pneumonia (due to the high mortality of intensive care-associated pneumonia) and to report outcomes according to various types of comorbidity.
Multicenter observational cohort study on the prospective Outcomerea database, including adult patients, with a hospital stay < 48 h before ICU admission and a documented IPI within the first 72 h of ICU admission. Comorbid conditions were defined according to the Knaus and Charlson classification.
Of the 20,235 patients, 5310 (26.4%) had an invasive infection, including 560/5,310 (10.6%) who had an IPI. The ICU 28-day mortality was 109/560 (19.8%). Four factors were independently associated with mortality: SOFA day 1–2: [hazard ratio (HR) 1.21; 95% confidence interval (95% CI) 1.15–1.27, p < 0.001]; maximum lactate level day 1–2: (HR 1.07, 95% CI 1.02–1.12, p = 0.006); diabetes mellitus: (HR 1.91, 95% CI 1.23–3.03, p = 0.006) and appropriate antibiotics (HR 0.28, 95% CI 0.15–0.50, p < 0.001). Comparable results were obtained when other comorbid conditions were forced into the model. Diabetes impact was more pronounced in case of micro- or macro-angiopathy (HR 4.17, 95%CI 1.68–10.54, p = 0.003), in patients ≥ 65 years old (HR 2.59, 95% CI 1.56–4.28, < 0.001) and in those with body mass index (BMI) < 25 kg/m2 (HR 2.11, 95% CI 1.10–4.06, p = 0.025).
Diabetes mellitus was the only comorbid condition which independently influenced mortality in patients with IPI. Its impact was more pronounced in patients with complications, aged ≥ 65 years and with BMI < 25 kg/m2.
KeywordsDiabetes mellitus Intensive care unit Critical care Invasive pneumococcal infection
We thank Celine Feger, MD (EMIBiotech), for her assistance in preparing the manuscript, and ICUREsearch SAS for the statistical analysis.
MGO wrote the manuscript and MGO, EA, SR and JFT interpreted the data. All authors read the manuscript and approved the final manuscript.
The study was granted by PfizerTM which had no role in the design, conduct or data analysis of the present study or in the decision to submit the manuscript for publication.
Compliance with ethical standards
Conflict of interest
MGO: shares in ICUREsearch. JFT: scientific board: ICUREsearch, Bayer, Merk, Paratek, 3M, Gilead. Lectures for Gilead, Pfizer, Merck, Astellas. Grants from Pfizer, 3M, Merck, Astellas. EA: is part of the board of Gilead Sciences. He has received fees for lecture from Gilead, Astellas, MSD, Alexion and Baxter. His institution has received research support from Glead, Pfizer, Fisher & Payckle, Jazz pharma, Alexion and Basilea. SR, JRZ: shares in ICUREsearch, JPB: scientific board Pfizer, Lectures Pfizer, MSD. No conflict of interests: LA, GM, CS, EdM, JPB, BS, CA, DGT, ASD, HK, SJ, MD.
- 7.Tomczyks T, Bennett N, Stoecker C, Gierke R, Moore M, Whitney C, et al. Use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine among adults aged ≥ 65 years: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep. 2014;63:822–5.Google Scholar
- 19.Cilloniz C, Ferrer M, Liapikou A, Garcia-Vidal C, Gabarrus A, Ceccato A, et al. Acute respiratory distress syndrome in mechanically-ventilated patients with community-acquired pneumonia. Eur Respir J. 2018;29:51.Google Scholar
- 22.Annane D, Bellissant E, Bollaert PE, Briegel J, Keh D, Kupfer Y. Corticosteroids for treating sepsis. Cochrane Database Syst Rev. 2015;12:CD002243.Google Scholar
- 24.Torres A, Blasi F, Dartois N, Akova M. Which individuals are at increased risk of pneumococcal disease and why? Impact of COPD, asthma, smoking, diabetes, and/or chronic heart disease on community-acquired pneumonia and invasive pneumococcal disease. Thorax. 2015;70:984–9.CrossRefPubMedPubMedCentralGoogle Scholar
- 37.Calendrier des vaccinations et recommendations vaccinales 2018 en France. 2018. http://solidarites-sante.gouv.fr/prevention-en-sante/preserver-sa-sante/vaccination/calendrier-vaccinal.
- 38.Prevention CfDCa. Pneumococcal vaccination. 2016. https://www.cdc.gov/vaccines/vpd/pneumo/.