Jacques Gaillat1, Amine Benadji2, Xavier Duval3,4, Kostas Danis5, Bruno Hoen6, Bernard Page7, Guillaume Béraud8, Véronique Vernet-Garnier9, Christophe Strady10, Nathalie Brieu11, Laurence Maulin12, Carine Roy13, Marie-Cécile Ploy14,15, Emmanuelle Varon16, Sarah Tubiana2,17. 1. Hospital Centre Annecy Genevois, Annecy, France. 2. AP-HP, Centre d'Investigation Clinique, Inserm CIC 1425, Hôpital Bichat Claude Bernard, 46, Rue Henri Huchard, 75018, Paris, France. 3. AP-HP, Centre d'Investigation Clinique, Inserm CIC 1425, Hôpital Bichat Claude Bernard, 46, Rue Henri Huchard, 75018, Paris, France. xavier.duval@aphp.fr. 4. IAME, INSERM, Université de Paris, 75018, Paris, France. xavier.duval@aphp.fr. 5. Santé Publique France, The French National Public Health Agency, Saint Maurice, France. 6. Service de Maladies Infectieuses et Tropicales, University Hospital Nancy, Hôpitaux de Brabois, 54511, Vandoeuvre-lès-Nancy, France. 7. AP-HP, Intensive Care Unit, Ambroise Paré Hospital, Boulogne-Billancourt, France. 8. Médecine Interne et Maladies Infectieuses, CHU de Poitiers, 86021, Poitiers, France. 9. Laboratoire de Bactériologie-Hygiène, CHU Reims, Reims, France. 10. Cabinet d'Infectiologie, Clinique Courlancy, Groupe Courlancy-Reims, Reims, France. 11. General Hospital, Aix-en-Provence, France. 12. Infectiologie, Centre Hospitalier du Pays d'Aix, Aix-en-Provence, France. 13. AP-HP, Unité de Recherche Clinique, Paris Nord, Hôpital Bichat, Paris, France. 14. Regional Observatories for Pneumococci (Observatoires Régionaux du Pneumocoque), University Hospital Centre Limoges, Limoges, France. 15. INSERM, CHU Limoges, RESINFIT, University of Limoges, U1092, F-87000, Limoges, France. 16. National Centre for Pneumococci, Centre Hospitalier Intercommunal Créteil, Créteil, France. 17. IAME, INSERM, Université de Paris, 75018, Paris, France.
Abstract
PURPOSE: Invasive pneumococcal disease (IPD) is responsible for substantial mortality and morbidity worldwide. We aimed to identify host and bacterial factors associated with 30-day mortality in 18-year-old patients hospitalized with IPD in France from 2013 to 2015. METHODS: This study analyzed data collected from consecutives IPD cases included in two parallel multi-center cohort studies: COMBAT study (280 patients with pneumococcal community-acquired bacterial meningitis) and SIIP study (491 patients with non-meningitis IPD). Factors associated with 30-day mortality were identified using logistic regression. RESULTS: Among the 771 enrolled patients (median age 66 years, IQR [52.0-79.7]), 592/767 (77.2%) had at least one chronic disease. Patients with meningitis were younger (60.2 vs 70.9 years; p < 0.001) and had fewer chronic diseases than those with non-meningitis IPD (73.3% vs 79.4%; p = 0.05). Non-vaccine serotypes were more frequent in meningitis patients than in those with other IPD (36.1% vs 23.1%; p < 0.001). The overall 30-day mortality was 16.7% and patients with concurrent meningitis and extra-cerebral IPD had the highest 30-day mortality rate (26.5%). On multivariate analyses, older age, history of malignant solid tumor, meningeal IPD and serotypes previously identified with high mortality potential were independently associated with 30-day mortality. Of the serotypes with high mortality potential, 80% were included in licensed (PCV13 or PPV23) vaccines. CONCLUSION: We observed an effect of both host factors and pneumococcal serotypes on 30-day mortality in IPD. This highlights the need for a focused strategy to vaccinate at-risk patients. CLINICAL TRIAL: ClinicalTrial. Gov identification number: NCT01730690.
PURPOSE: Invasive pneumococcal disease (IPD) is responsible for substantial mortality and morbidity worldwide. We aimed to identify host and bacterial factors associated with 30-day mortality in 18-year-old patients hospitalized with IPD in France from 2013 to 2015. METHODS: This study analyzed data collected from consecutives IPD cases included in two parallel multi-center cohort studies: COMBAT study (280 patients with pneumococcal community-acquired bacterial meningitis) and SIIP study (491 patients with non-meningitis IPD). Factors associated with 30-day mortality were identified using logistic regression. RESULTS: Among the 771 enrolled patients (median age 66 years, IQR [52.0-79.7]), 592/767 (77.2%) had at least one chronic disease. Patients with meningitis were younger (60.2 vs 70.9 years; p < 0.001) and had fewer chronic diseases than those with non-meningitis IPD (73.3% vs 79.4%; p = 0.05). Non-vaccine serotypes were more frequent in meningitis patients than in those with other IPD (36.1% vs 23.1%; p < 0.001). The overall 30-day mortality was 16.7% and patients with concurrent meningitis and extra-cerebral IPD had the highest 30-day mortality rate (26.5%). On multivariate analyses, older age, history of malignant solid tumor, meningeal IPD and serotypes previously identified with high mortality potential were independently associated with 30-day mortality. Of the serotypes with high mortality potential, 80% were included in licensed (PCV13 or PPV23) vaccines. CONCLUSION: We observed an effect of both host factors and pneumococcal serotypes on 30-day mortality in IPD. This highlights the need for a focused strategy to vaccinate at-risk patients. CLINICAL TRIAL: ClinicalTrial. Gov identification number: NCT01730690.
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