, Volume 46, Issue 5, pp 669–677 | Cite as

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

  • Maité Garrouste-OrgeasEmail author
  • Elie Azoulay
  • Stéphane Ruckly
  • Carole Schwebel
  • Etienne de Montmollin
  • Jean-Pierre Bedos
  • Bertrand Souweine
  • Guillaume Marcotte
  • Christophe Adrie
  • Dany Goldgran-Toledano
  • Anne-Sylvie Dumenil
  • Hatem Kallel
  • Samir Jamali
  • Laurent Argaud
  • Michael Darmon
  • Jean-Ralph Zahar
  • J. F. Timsit
Original Paper



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.


Diabetes 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.

Author contributions

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.

Supplementary material

15010_2018_1169_MOESM1_ESM.docx (31 kb)
Supplementary material 1 (DOCX 31 KB)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Maité Garrouste-Orgeas
    • 1
    • 2
    • 3
    Email author
  • Elie Azoulay
    • 4
  • Stéphane Ruckly
    • 3
  • Carole Schwebel
    • 5
  • Etienne de Montmollin
    • 6
  • Jean-Pierre Bedos
    • 7
  • Bertrand Souweine
    • 8
  • Guillaume Marcotte
    • 9
  • Christophe Adrie
    • 10
  • Dany Goldgran-Toledano
    • 11
  • Anne-Sylvie Dumenil
    • 12
  • Hatem Kallel
    • 13
  • Samir Jamali
    • 14
  • Laurent Argaud
    • 15
  • Michael Darmon
    • 16
    • 17
  • Jean-Ralph Zahar
    • 18
  • J. F. Timsit
    • 1
    • 3
    • 19
  1. 1.UMR 1137, IAME Team 5, DeSCID: Decision Sciences in Infectious Diseases, Control and Care, Sorbonne Paris CitéInserm/Paris Diderot UniversityParisFrance
  2. 2.Medical UnitFrench and British InstituteLevallois-PerretFrance
  3. 3.Outcomerea Research GroupParisFrance
  4. 4.Medical Intensive Care UnitSaint Louis University HospitalParisFrance
  5. 5.Medical Intensive Care UnitAlbert Michallon HospitalGrenobleFrance
  6. 6.Medical-Surgical Intensive Care UnitDelafontaine HospitalSaint-DenisFrance
  7. 7.Medical Intensive Care UnitAndré Mignot HospitalLe ChesnayFrance
  8. 8.Medical Intensive Care UnitGabriel Montpied University HospitalClermont-FerrandFrance
  9. 9.Surgical ICUEdouard Herriot University HospitalLyonFrance
  10. 10.Physiology department, Cochin University HospitalParis Descartes UniversityParisFrance
  11. 11.Medical-Surgical Intensive Care UnitMontfermeilFrance
  12. 12.Medical Intensive Care UnitAntoine Béclère HospitalClamartFrance
  13. 13.Medical-Surgical UnitAndrée Rosemon HospitalCayenneFrance
  14. 14.Medical-Surgical UnitSud-Essonne HospitalDourdanFrance
  15. 15.Medical Intensive Care UnitEdouard Herriot University HospitalLyonFrance
  16. 16.Medical Intensive Care UnitSaint Etienne University HospitalSaint-ÉtienneFrance
  17. 17.Jacques Lisfranc Medicine UniversityJean Monnet UniversitySaint-ÉtienneFrance
  18. 18.Infection Control UnitAvicenne University HospitalBobignyFrance
  19. 19.Medical and Infectious Diseases Intensive Care Unit, Bichat University HospitalParis Diderot UniversityParisFrance

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