RESUMO
BACKGROUND: Pneumococcal pneumonia (PP) is a serious infection caused by Streptococcus pneumoniae (pneumococcus), with a wide spectrum of clinical manifestations. The aim of this study was to analyze the comorbidity factors that influenced the mortality in patients with asplenia according to PP. METHODS: Discharge reports from the Spanish Minimum Basic Data Set (MBDS) was used to retrospectively analyze patients with asplenia and PP, from 1997 to 2021. Elixhauser Comorbidity Index (ECI) was calculated to predict in-hospital mortality (IHM). RESULTS: 97,922 patients with asplenia were included and 381 cases of PP were identified. The average age for men was 63.87 years and for women 65.99 years. In all years, ECI was larger for splenectomized than for non-splenectomized patients, with men having a higher mean ECI than women. An association was found between risk factors ECI, splenectomy, age group, sex, pneumococcal pneumonia, and increased mortality (OR = 0.98; 95% CI: 0.97-0.99; p < 0.001). The IHM increased steadily with the number of comorbidities and index scores in 1997-2021. CONCLUSIONS: Asplenia remain a relevant cause of hospitalization in Spain. Comorbidities reflected a great impact in patients with asplenia and PP, which would mean higher risk of mortality.
Assuntos
Comorbidade , Mortalidade Hospitalar , Pneumonia Pneumocócica , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Pneumonia Pneumocócica/mortalidade , Pneumonia Pneumocócica/epidemiologia , Espanha/epidemiologia , Idoso , Estudos Retrospectivos , Fatores de Risco , Esplenectomia , Streptococcus pneumoniae/isolamento & purificação , Adulto , Idoso de 80 Anos ou mais , Pacientes Internados/estatística & dados numéricos , Hospitalização/estatística & dados numéricosRESUMO
INTRODUCTION: Despite improvements in health care, pneumonia-associated mortality remains high. The objective of this study was to analyze the factors associated with mortality in bacteremic pneumonia caused by pneumococcus. METHODS: Retrospective cohort study in adult patients with pneumonia diagnosis and isolation of pneumococcus in blood cultures, between January 2012 and May 2021, was carried out. Clinical and laboratory variables, radiological involvement, evolution and mortality during hospitalization were analyzed. The group of deceased patients was compared with that of survivors. RESULTS: 152 patients were included. Median age: 58 years; men: 58.9%; 33% presented a CURB-65 > than 2 at admission. Overall mortality: 34% (n=52). Deceased patients were more tachypneic on admission (respiratory rate 26 vs. 22; p=0.003), presented sensory alteration more frequently (58% vs. 14%; p< 0.001), PaO2/fraction of inspired oxygen ratio < 250 (58% vs. 22%; p<0.001), bilateral radiological compromise (50% vs. 32%; p=0.03), needed mechanical ventilation (50% vs 12%; p< 0.001), higher blood creatinine values (1.6 vs. 1.15; p=0.01), lower white blood cell count (10 900 vs 17 400; p=0.002), a lower glucose dosage (111 vs. 120; p=0.01), and fewer days of hospital stay (6 vs. 9; p=0.015). In logistic regression model, significant differences were maintained in the following factors associated with mortality: mechanical ventilation (OR=3.54), altered mental status (OR=5.95), chest X-ray with bilateral compromise (OR 3.20) and PAFI less than 250 (OR=3.62). CONCLUSION: In our series, the factors related to mortality, despite the presence of bacteremia, do not differ from those published in the literature and which are part of the different prognostic scores used in routine practice.
Introducción: A pesar de las mejoras en los cuidados de la salud, la mortalidad asociada a neumonía continúa siendo alta. El objetivo de este estudio fue analizar los factores asociados a mortalidad en neumonía bacteriémica por neumococo. Métodos: Estudio de cohorte retrospectiva en pacientes adultos con diagnóstico de neumonía y neumococo aislado en hemocultivos, entre enero 2012 y mayo 2021. Se analizaron: variables clínicas y de laboratorio, compromiso radiológico, evolución y mortalidad durante la internación. Se comparó el grupo de pacientes fallecidos con el de sobrevivientes. Resultados: Se incluyeron 152 pacientes. La mediana de edad fue de 58 años y el 58.9% fueron hombres. El 33% presentó un CURB-65 mayor a 2 al momento de internación. La mortalidad global fue 34% (n=52). Los pacientes fallecidos se encontraban más frecuentemente taquipneicos al ingreso (frecuencia respiratoria 26 vs. 22; p=0.003), presentaban más frecuentemente alteración del sensorio (58% vs. 14%; p< 0.001), PaO2/fracción inspirada de oxígeno (PAFI) < 250 (58% vs. 22%; p<0.001), compromiso radiológico bilateral (50% vs. 32%; p=0.03), necesidad de asistencia respiratoria mecánica (ARM) (50% vs. 12%; p< 0.001), mayor valor de creatinina en sangre (1.6 vs. 1.15; p=0.01), menor recuento de glóbulos blancos (10 900 vs. 17 400; p=0.002), menor valor de glucemia (111 vs. 120; p=0.01) y menos días de estancia hospitalaria (6 vs. 9; p=0.015). En el análisis de regresión logística multivariable se mantuvieron diferencias significativas en los siguientes factores asociados a mortalidad: ventilación mecánica (OR=3.54), confusión (OR=5.95), radiografía con compromiso bilateral (OR= 3.20) y PAFI < 250 (OR=3.62). Conclusión: Los factores relacionados con mortalidad, a pesar de la presencia de bacteriemia, no difieren de los publicados en la literatura y forman parte de los scores pronósticos de práctica habitual.
Assuntos
Pneumonia Pneumocócica , Humanos , Masculino , Estudos Retrospectivos , Pessoa de Meia-Idade , Feminino , Idoso , Pneumonia Pneumocócica/mortalidade , Fatores de Risco , Adulto , Streptococcus pneumoniae , Mortalidade Hospitalar , Bacteriemia/mortalidade , Bacteriemia/microbiologiaRESUMO
OBJECTIVE: Pneumococcal pneumonia is a significant cause of morbidity and mortality among adults. The study's main aim was to evaluate the in-hospital mortality and related costs of community-acquired pneumococcal pneumonia in adults. METHODS: This cross-sectional study used medical records of adult patients with pneumococcal pneumonia hospitalized in a university hospital in Brazil from October 2009 to April 2017. All patients aged ≥ 18 years diagnosed with pneumococcal pneumonia were included. Risk factors, intensive care unit admission, length of hospital stay, in-hospital mortality, and direct and indirect costs were analyzed. RESULTS: In total, 186 patients were selected. The mean in-hospital mortality rate was 18% for adults aged < 65 years and 23% for the elderly (≥ 65 years). Bacteremic pneumococcal pneumonia affected 20% of patients in both groups, mainly through chronic respiratory disease (adjusted OR: 3.07, 95% CI: 1.23-7.65, p < 0.01). Over 7 years, annual total direct and indirect costs were USD 28,188 for adults < 65 years (USD 1,746 per capita) and USD 16,350 for the elderly (USD 2,119 per capita). CONCLUSION: Pneumococcal pneumonia remains an important cause of morbidity and mortality among adults, significantly affecting direct and indirect costs. These results suggest the need for prevention strategies for all adults, especially for patients with chronic respiratory diseases.
OBJETIVO: A pneumonia pneumocócica é uma causa significativa de morbimortalidade entre adultos. Desta maneira, o objetivo principal deste estudo foi avaliar a mortalidade intra-hospitalar e os custos relacionados à doença adquirida em adultos. MÉTODOS: Este estudo transversal utilizou prontuários de pacientes adultos com pneumonia pneumocócica internados em um hospital universitário no Brasil, de outubro de 2009 a abril de 2017. Todos os pacientes com idade ≥ 18 anos e diagnosticados com pneumonia pneumocócica foram incluídos. Dados como os fatores de risco, a internação em unidade de terapia intensiva, o tempo de internação, a mortalidade hospitalar e os custos diretos e indiretos foram analisados. RESULTADOS: No total, 186 pacientes foram selecionados. A taxa média de mortalidade intra-hospitalar foi de 18% para adultos com idade < 65 anos e 23% para os idosos (≥ 65 anos). A pneumonia pneumocócica bacterêmica acometeu 20% dos pacientes em ambos os grupos, principalmente por doença respiratória crônica (OR ajustada: 3,07; IC95%: 1,237,65; p < 0,01). Após levantamento das internações ocorridas no período de sete anos de tratamento, verificou-se que os custos diretos e indiretos totais anuais foram de US$ 28.188 para adultos < 65 anos (US$ 1.746 per capita) e US$ 16.350 para os idosos (US$ 2.119 per capita). CONCLUSÃO: A pneumonia pneumocócica continua sendo uma importante causa de morbimortalidade entre adultos, afetando significativamente os custos diretos e indiretos. Esses resultados sugerem a necessidade de estratégias de prevenção para todos os adultos, especialmente para pacientes com doenças respiratórias crônicas.
Assuntos
Mortalidade Hospitalar , Pneumonia Pneumocócica/economia , Pneumonia Pneumocócica/mortalidade , Adulto , Idoso , Brasil/epidemiologia , Infecções Comunitárias Adquiridas/economia , Infecções Comunitárias Adquiridas/mortalidade , Comorbidade , Estudos Transversais , Feminino , Hospitalização/economia , Humanos , Estimativa de Kaplan-Meier , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Fatores de TempoRESUMO
BACKGROUND: Understanding the real-world effect of pneumococcal conjugate vaccines (PCVs) on pneumonia mortality is crucial because of the expectation that increased PCV use will substantially reduce the burden of pneumonia deaths in children younger than 5 years. However, few post-vaccine introduction studies have estimated the benefits of PCV use on childhood mortality and results have been inconsistent. Therefore, we set out to assess the effect of introduction of ten-valent pneumococcal conjugate vaccine (PCV10) on pneumonia mortality in children in Brazil. METHODS: In this retrospective observational study, we used publicly available mortality data of children aged 3-59 months in Brazil. We separated data by age group (3-11 months, 3-23 months, and 3-59 months) and stratified data by three different socioeconomic factors of Brazilian municipalities (in 2010): Human Development Index, proportion of children living in extreme poverty, and proportion of mothers with no primary education. We first examined long-term trends in childhood pneumonia mortality in Brazil (from 1980 to 2014). We then assessed the effect of PCV10-introduced in Brazil in 2010-both nationally and in municipalities stratified by socioeconomic status, with a synthetic control approach as our primary analytical method. FINDINGS: Between 1980 and 2010, a period during which Brazil's Human Development Index rose substantially, national pneumonia mortality in children younger than 5 years decreased from about 150 to 15 deaths per 100â000 children younger than 5 years. Despite rapid uptake of PCV10 after its introduction in 2010, we observed a further vaccine-associated decline of about 10% in national childhood pneumonia mortality with our primary analytical method, with a high degree of uncertainty in the estimates. We observed larger reductions in municipal childhood pneumonia mortality in all three age groups (3-11 months, 3-23 months, and 3-59 months) in municipalities with a high percentage of extreme childhood poverty and mothers with no primary education, with the largest decrease observed in children aged 3-23 months in municipalities with low maternal education (24%, 95% credible interval 7-35). INTERPRETATION: The large reduction observed from 1980 to 2010 in national pneumonia mortality in children younger than 5 years underscores that improvements in nutrition, hygiene, education, and health care have an important role in reducing pneumonia mortality. Although the PCV-associated reduction in childhood pneumonia mortality at the national level was modest, we found that PCV led to larger reductions in low-income municipalities. Similarly, large benefits might occur when PCVs are introduced in other low-income settings. FUNDING: Bill & Melinda Gates Foundation and National Institute of Allergy and Infectious Diseases.
Assuntos
Vacinas Pneumocócicas/uso terapêutico , Pneumonia Pneumocócica/prevenção & controle , Pneumonia/mortalidade , Brasil/epidemiologia , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pneumonia Pneumocócica/mortalidade , Estudos RetrospectivosRESUMO
RESUMO Objetivo A pneumonia pneumocócica é uma causa significativa de morbimortalidade entre adultos. Desta maneira, o objetivo principal deste estudo foi avaliar a mortalidade intra-hospitalar e os custos relacionados à doença adquirida em adultos. Métodos Este estudo transversal utilizou prontuários de pacientes adultos com pneumonia pneumocócica internados em um hospital universitário no Brasil, de outubro de 2009 a abril de 2017. Todos os pacientes com idade ≥ 18 anos e diagnosticados com pneumonia pneumocócica foram incluídos. Dados como os fatores de risco, a internação em unidade de terapia intensiva, o tempo de internação, a mortalidade hospitalar e os custos diretos e indiretos foram analisados. Resultados No total, 186 pacientes foram selecionados. A taxa média de mortalidade intra-hospitalar foi de 18% para adultos com idade < 65 anos e 23% para os idosos (≥ 65 anos). A pneumonia pneumocócica bacterêmica acometeu 20% dos pacientes em ambos os grupos, principalmente por doença respiratória crônica (OR ajustada: 3,07; IC95%: 1,23‐7,65; p < 0,01). Após levantamento das internações ocorridas no período de sete anos de tratamento, verificou-se que os custos diretos e indiretos totais anuais foram de US$ 28.188 para adultos < 65 anos (US$ 1.746 per capita) e US$ 16.350 para os idosos (US$ 2.119 per capita). Conclusão A pneumonia pneumocócica continua sendo uma importante causa de morbimortalidade entre adultos, afetando significativamente os custos diretos e indiretos. Esses resultados sugerem a necessidade de estratégias de prevenção para todos os adultos, especialmente para pacientes com doenças respiratórias crônicas.
ABSTRACT Objective Pneumococcal pneumonia is a significant cause of morbidity and mortality among adults. The study's main aim was to evaluate the in-hospital mortality and related costs of community-acquired pneumococcal pneumonia in adults. Methods This cross-sectional study used medical records of adult patients with pneumococcal pneumonia hospitalized in a university hospital in Brazil from October 2009 to April 2017. All patients aged ≥ 18 years diagnosed with pneumococcal pneumonia were included. Risk factors, intensive care unit admission, length of hospital stay, in-hospital mortality, and direct and indirect costs were analyzed. Results In total, 186 patients were selected. The mean in-hospital mortality rate was 18% for adults aged < 65 years and 23% for the elderly (≥ 65 years). Bacteremic pneumococcal pneumonia affected 20% of patients in both groups, mainly through chronic respiratory disease (adjusted OR: 3.07, 95% CI: 1.23-7.65, p < 0.01). Over 7 years, annual total direct and indirect costs were USD 28,188 for adults < 65 years (USD 1,746 per capita) and USD 16,350 for the elderly (USD 2,119 per capita). Conclusion Pneumococcal pneumonia remains an important cause of morbidity and mortality among adults, significantly affecting direct and indirect costs. These results suggest the need for prevention strategies for all adults, especially for patients with chronic respiratory diseases.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Pneumonia Pneumocócica/economia , Pneumonia Pneumocócica/mortalidade , Mortalidade Hospitalar , Fatores de Tempo , Brasil/epidemiologia , Comorbidade , Modelos Logísticos , Estudos Transversais , Fatores de Risco , Infecções Comunitárias Adquiridas/economia , Infecções Comunitárias Adquiridas/mortalidade , Estimativa de Kaplan-Meier , Hospitalização/economiaRESUMO
BACKGROUND: Bacteremic pneumococcal pneumonia (BPP) is a preventable disease with high morbimortality. AIM: To evaluate clinical aspects and mortality on BPP patients admitted to a Chilean regional hospital. PATIENTS AND METHODS: We looked for adult patients with Streptococcus pneumoniae isolated from blood cultures between 2010 and 2014 years and reviewed clinical records of those who were admitted with pneumonia. RESULTS: We identified 70 BPP patients: 58% were men, mean age was 56 years, 30% were > 65 years, 70% with basic public health insurance, 26% were alcoholics, 86% had comorbidities. Only two patients were vaccinated against S. pneumoniae. CURB-65 severity index for community acquired pneumonia was > 3 in 37% of patients. Twenty-four patients were admitted to ICU, twenty required mechanical ventilation and twenty-four died (34%). Mortality was associated with an age over 65 years, presence of comorbidities and complications of pneumonia. A total of 22 serotypes of S. pneumoniae were identified, five of them (1,3,7F,14 y 9V) were present in 57% of cases. CONCLUSIONS: Elevated mortality of our BNN patients was associated with comorbidities and possibly with socio economic factors, which conditioned a late access to medical care.
Assuntos
Bacteriemia/mortalidade , Pneumonia Pneumocócica/mortalidade , Idoso , Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Bacteriemia/microbiologia , Ceftriaxona/uso terapêutico , Chile/epidemiologia , Infecções Comunitárias Adquiridas/tratamento farmacológico , Infecções Comunitárias Adquiridas/microbiologia , Infecções Comunitárias Adquiridas/mortalidade , Comorbidade , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia Pneumocócica/diagnóstico , Pneumonia Pneumocócica/tratamento farmacológico , Pneumonia Pneumocócica/microbiologia , Fatores de Risco , Índice de Gravidade de Doença , Fatores Socioeconômicos , Streptococcus pneumoniae/isolamento & purificaçãoRESUMO
BACKGROUND: Children immunization with pneumococcal conjugate vaccine (PCV) had profound public health effects across the globe. Colombian adopted PCV10 universal vaccination, but PCV incremental impact need to be revalued. The objective of this analysis was to estimate the cost-effectiveness of switch to PCV13 versus continue PCV10 in Colombian children. METHODS: A complete economic analysis was carried-out assessing potential epidemiological and economic impact of switching from PCV10 to PCV13. Epidemiological information on PCV10 impact was obtained from lab-based epidemiological surveillance on pneumococcal isolates at the Colombian National Institute of Health. Economic inputs were extracted from the literature. Incremental PCV13 effectiveness was based in additional serotypes included. Comparisons among alternatives were evaluated with the Incremental Cost-Effectiveness Ratio (ICER) at a willingness to pay of one GDP per capita (USD$ 6631) per Year of Live Saved (YLS). All costs were reported in 2014USD. Deterministic and probabilistic sensitivity analyses were performed, and 95% confidence interval reported. RESULTS: After four years using PCV10 for universal vaccination on children the Colombian health surveillance system showed a relative increment on non PCV10 isolates. To change from PCV10 to PCV13 would avoid 587 (CI95% -49-1008) ambulatory Rx community-acquired pneumoniae (CAP), 1622 (CI95% 591-2343) Inpatient RxCAP, 10 (CI 95% 6-11) pneumococcal meningitis, and 79 (CI95% 76-98) deaths. ICER per YLS was USD$ 2319 (CI95% Dominated - USD$ 4225) for Keep-PCV10 and USD$ 1771 (CI95% USD$ 1285-9884) for Switch-to PCV13. In spite of its cost-effectiveness Keep-PCV10 is an extended dominated alternative and Switch-to PCV13 would be preferred. Results are robust to parameters changes in the sensitivity analyses. CONCLUSION: A national immunization strategy based in Switch-to PCV13 was found to be good value for money and prevent additional burden of pneumococcal disease saving additional treatment costs, when compared with to Keep-PCV10 in Colombia, however additional criteria to decision making must be taken into account.
Assuntos
Análise Custo-Benefício , Programas de Imunização/economia , Vacinação em Massa/economia , Meningite Pneumocócica/economia , Vacinas Pneumocócicas/economia , Pneumonia Pneumocócica/economia , Colômbia , Países em Desenvolvimento , Custos de Cuidados de Saúde , Política de Saúde/economia , Humanos , Meningite Pneumocócica/mortalidade , Meningite Pneumocócica/prevenção & controle , Vacinas Pneumocócicas/administração & dosagem , Pneumonia Pneumocócica/mortalidade , Pneumonia Pneumocócica/prevenção & controle , Streptococcus pneumoniae/isolamento & purificaçãoRESUMO
Background: Bacteremic pneumococcal pneumonia (BPP) is a preventable disease with high morbimortality. Aim: To evaluate clinical aspects and mortality on BPP patients admitted to a Chilean regional hospital. Patients and Methods: We looked for adult patients with Streptococcus pneumoniae isolated from blood cultures between 2010 and 2014 years and reviewed clinical records of those who were admitted with pneumonia. Results: We identified 70 BPP patients: 58% were men, mean age was 56 years, 30% were > 65 years, 70% with basic public health insurance, 26% were alcoholics, 86% had comorbidities. Only two patients were vaccinated against S. pneumoniae. CURB-65 severity index for community acquired pneumonia was > 3 in 37% of patients. Twenty-four patients were admitted to ICU, twenty required mechanical ventilation and twenty-four died (34%). Mortality was associated with an age over 65 years, presence of comorbidities and complications of pneumonia. A total of 22 serotypes of S. pneumoniae were identified, five of them (1,3,7F,14 y 9V) were present in 57% of cases. Conclusions: Elevated mortality of our BNN patients was associated with comorbidities and possibly with socio economic factors, which conditioned a late access to medical care.
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Pneumonia Pneumocócica/mortalidade , Bacteriemia/mortalidade , Pneumonia Pneumocócica/diagnóstico , Pneumonia Pneumocócica/microbiologia , Pneumonia Pneumocócica/tratamento farmacológico , Fatores Socioeconômicos , Streptococcus pneumoniae/isolamento & purificação , Índice de Gravidade de Doença , Ceftriaxona/uso terapêutico , Comorbidade , Chile/epidemiologia , Fatores de Risco , Mortalidade Hospitalar , Bacteriemia/microbiologia , Bacteriemia/tratamento farmacológico , Infecções Comunitárias Adquiridas/microbiologia , Infecções Comunitárias Adquiridas/mortalidade , Infecções Comunitárias Adquiridas/tratamento farmacológico , Antibacterianos/uso terapêuticoRESUMO
BACKGROUND: Although antibiotic de-escalation is regarded as a measure that reduces selection pressure, adverse drug effects and costs, evidence supporting this practice in community-acquired pneumococcal pneumonia (CAPP) is lacking. METHODS: We carried out a retrospective analysis of prospectively collected data of a cohort of hospitalized adults with CAPP. Pneumococcal aetiology was established in patients with one or more positive cultures for Streptococcus pneumoniae obtained from blood, sterile fluids or sputum, and/or a positive urinary antigen test. De-escalation therapy was considered when the initial antibiotic therapy was narrowed to penicillin, amoxicillin or amoxicillin/clavulanate within the first 72 h after admission. The primary outcomes were 30 day mortality and length of hospital stay (LOS). Adjustment for confounders was performed with multivariate and propensity score analyses. RESULTS: Of 1410 episodes of CAPP, antibiotic de-escalation within the first 72 h after admission was performed in 166 cases. After adjustment, antibiotic de-escalation was not associated with a higher risk of mortality (ORâ=â0.83, 95% CIâ=â0.24-2.81), but it was found to be a protective factor for prolonged LOS (above the median) (ORâ=â0.46, 95% CIâ=â0.30-0.70). Similar results were found in patients classified into high-risk pneumonia severity index classes (IV-V), those with clinical instability and those with bacteraemia. No significant differences were documented in adverse drug reactions or readmission (<30 days). CONCLUSIONS: Antibiotic de-escalation seems to be safe and effective in reducing the duration of LOS, and did not adversely affect outcomes of patients with CAPP, even those with bacteraemia and severe disease, and those who were clinically unstable.
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Combinação Amoxicilina e Clavulanato de Potássio/uso terapêutico , Amoxicilina/uso terapêutico , Antibacterianos/administração & dosagem , Antibacterianos/efeitos adversos , Bacteriemia/tratamento farmacológico , Infecções Comunitárias Adquiridas/tratamento farmacológico , Penicilinas/uso terapêutico , Pneumonia Pneumocócica/tratamento farmacológico , Idoso , Amoxicilina/administração & dosagem , Amoxicilina/efeitos adversos , Combinação Amoxicilina e Clavulanato de Potássio/administração & dosagem , Combinação Amoxicilina e Clavulanato de Potássio/efeitos adversos , Antibacterianos/uso terapêutico , Bacteriemia/mortalidade , Infecções Comunitárias Adquiridas/mortalidade , Feminino , Hospitalização , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Penicilinas/administração & dosagem , Penicilinas/efeitos adversos , Pneumonia Pneumocócica/mortalidade , Estudos Prospectivos , Estudos Retrospectivos , Streptococcus pneumoniae/efeitos dos fármacos , Streptococcus pneumoniae/isolamento & purificação , Resultado do TratamentoRESUMO
Introducción: Streptoccocus pneumoniae es la causa más frecuente de neumonía bacteriana adquirida en la comunidad en la edad pediátrica. Objetivo: estimar la proporción de casos hospitalizados y defunciones por neumonía, así como describir la utilización de servicios de atención al paciente grave en niños con neumonía y sepsis. Métodos: se realizó un estudio retrospectivo de series de casos de niños entre 1 mes a 18 años, 2002-2013, así como datos de ingreso por neumonía (confirmada radiológicamente) y sepsis, en la Unidad de Terapia Intensiva 2011-2013, del Hospital Pediátrico Centro Habana. Resultados: se registraron un total de 5 672 ingresos por neumonía, para una media de 469 casos anuales, más frecuente en varones (53,2 por ciento) y niños entre 1 a 4 años (55,1 por ciento). Se registraron 14 fallecidos (0,25 por ciento del total), de los cuales 9 fueron del sexo masculino (64,3 por ciento). Entre 2011-2013, el 6 a 9 por ciento de los niños con neumonía requirieron ingreso en unidades de atención al grave, con predominio también de preescolares. Conclusiones: los datos obtenidos pueden aportar evidencia indirecta de la magnitud de la enfermedad neumocócica en un hospital pediátrico(AU)
Introduction: Streptococcus pneumoniae is the most common cause of community-acquired bacterial pneumonia at pediatric ages. Objective: to estimate the ratio of hospitalized cases and deaths of pneumonia as well as to describe the use of services to severely-ill patients in children with pneumonia and sepsis. Methods: retrospective case-series study performed in children aged one to 18 years from 2002 to 2013 and of hospitalization data for pneumonia (X ray-confirmed) and sepsis in the intensive care unit from 2011 to 2013 in Centro Habana pediatric hospital. Results: a total number of 5 672 admissions for pneumonia were registered, for a mean of 469 cases yearly, more frequent in males (53.2 percent) and children aged one to four years (55.1 percent). There were 14 deaths (0.25 percent of total number) and nine of them were males (64.3 percent). From 2011 to 2013, six to nine percent of children with pneumonia required admission to the severely-ill patient care unit with predominance of pre-school children. Conclusions: the collected data may provide indirect evidence for analysis of the magnitude of pneumococcal disease in a pediatric hospital(AU)
Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Pneumonia Pneumocócica/mortalidade , Pneumonia Pneumocócica/epidemiologia , Relatos de Casos , Estudos Retrospectivos , HospitalizaçãoRESUMO
Pneumococcal infections are important for their morbidity and economic burden, but there is no economical data from adults patients in Chile. AIMS: Estimate direct medical costs of bacteremic pneumococcal pneumonia among adult patients hospitalized in a general hospital and to evaluate the sensitivity of ICD 10 discharge codes to capture infections from this pathogen. METHODS: Analysis of hospital charges by components in a group of patients admitted for bacteremic pneumococcal pneumonia, correction of values by inflation and conversion from CLP to US$. RESULTS: Data were collected from 59 patients admitted during 2005-2010, mean age 71.9 years. Average hospital charges for those managed in general wards reached 2,756 US$, 8,978 US$ for those managed in critical care units (CCU) and 6,025 for the whole group. Charges were higher in CCU (p < 0.001), and patients managed in these units generated 78.3% of the whole cost (n = 31; 52.5% from total). The median cost in general wards was 1,558 US$, and 3,993 in CCU. Main components were bed occupancy (37.8% of charges), and medications (27.4%). There were no differences associated to age, comorbidities, severity scores or mortality. No single ICD discharge code involved a S. pneumoniae bacteremic case (0% sensitivity) and only 2 cases were coded as pneumococcal pneumonia (3.4%). CONCLUSIONS: Mean hospital charges (~6,000 US dollars) or median values (~2,400 US dollars) were high, underlying the economic impact of this condition. Costs were higher among patients managed in CCU. Recognition of bacteremic pneumococcal infections by ICD 10 discharge codes has a very low sensitivity.
Assuntos
Custos Hospitalares/estatística & dados numéricos , Pneumonia Pneumocócica/economia , Adulto , Idoso , Idoso de 80 Anos ou mais , Chile/epidemiologia , Preços Hospitalares , Hospitais Gerais/economia , Humanos , Pessoa de Meia-Idade , Pneumonia Pneumocócica/mortalidade , Pneumonia Pneumocócica/terapia , Estudos Retrospectivos , Adulto JovemRESUMO
Pneumococcal infections are important for their morbidity and economic burden, but there is no economical data from adults patients in Chile. Aims. Estimate direct medical costs of bacteremic pneumococcal pneumonia among adult patients hospitalized in a general hospital and to evaluate the sensitivity of ICD 10 discharge codes to capture infections from this pathogen. Methods. Analysis of hospital charges by components in a group of patients admitted for bacteremic pneumococcal pneumonia, correction of values by inflation and conversion from CLP to US$. Results. Data were collected from 59 patients admitted during 2005-2010, mean age 71.9 years. Average hospital charges for those managed in general wards reached 2,756 US$, 8,978 US$ for those managed in critical care units (CCU) and 6,025 for the whole group. Charges were higher in CCU (p < 0.001), and patients managed in these units generated 78.3% of the whole cost (n = 31; 52.5% from total). The median cost in general wards was 1,558 US$, and 3,993 in CCU. Main components were bed occupancy (37.8% of charges), and medications (27.4%). There were no differences associated to age, comorbidities, severity scores or mortality. No single ICD discharge code involved a S. pneumoniae bacteremic case (0% sensitivity) and only 2 cases were coded as pneumococcal pneumonia (3.4%). Conclusions. Mean hospital charges (~6,000 US dollars) or median values (~2,400 US dollars) were high, underlying the economic impact of this condition. Costs were higher among patients managed in CCU. Recognition of bacteremic pneumococcal infections by ICD 10 discharge codes has a very low sensitivity.
Las infecciones neumocócicas representan una gran carga de morbilidad y de gastos en salud en pacientes adultos pero no se dispone de datos que hayan evaluado su dimensión económica en Chile. Objetivo: Evaluar los gastos directos en un grupo de pacientes adultos hospitalizados por neumonía neumocóccica bacterémica en un hospital general y evaluar la sensibilidad de los códigos de egreso CIE 10 para capturar las infecciones por este patógeno. Métodos: Análisis de gastos por componentes de un grupo de pacientes atendidos por neumonía neumocóccica bacteriémica, actualización de gastos y conversión a US$. Resultados: Se rescató información de 59 pacientes atendidos entre el 2005-2010, con edad promedio de 71,9 años. El gasto promedio en sala fue de 2.756 US$, de 8.978 US$ en Unidades Críticas y de 6.025 US$ para el grupo total. Los gastos fueron mayores en Unidades Críticas (p < 0,001) y los pacientes en estas unidades (n = 31; 52,5% del total) generaron el 78,3% del gasto total observado. La mediana de gastos en sala fue de 1.558 US$ y de 3.993 US$ en el caso de Unidades Críticas. El 37,8% del gasto se originó por día-cama y 27,4% por medicamentos. No hubo diferencias por edad, co-morbilidades, scores de gravedad o mortalidad. Ningún código CIE 10 involucró bacteriemia por S. pneumoniae (Sensibilidad 0%) y sólo 2 casos fueron codificados como neumonía neumocóccica (3,4%). Conclusiones: El gasto promedio (aprox. 6.000 dólares americanos) y mediana (aprox. 2.400 dólares americanos) fueron elevados evidenciando la importancia económica de esta enfermedad. Los gastos fueron mayores en pacientes manejados en Unidades Críticas. La sensibilidad de los códigos CIE 10 fue baja para reconocer eventos de ENI en esta serie.
Assuntos
Humanos , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Pneumonia Pneumocócica/economia , Custos Hospitalares/estatística & dados numéricos , Pneumonia Pneumocócica/mortalidade , Pneumonia Pneumocócica/terapia , Chile/epidemiologia , Estudos Retrospectivos , Preços Hospitalares , Hospitais Gerais/economiaRESUMO
BACKGROUND: The ten-valent pneumococcal conjugate vaccine (PCV10) was introduced into the Chilean National Immunization Program (NIP) in January 2011 with a 3+1 schedule (2, 4, 6 and 12 months) without catch-up vaccination. We evaluated the effectiveness of PCV10 on pneumonia morbidity and mortality among infants during the first two years after vaccine introduction. METHODS: This is a population-based nested case-control study using four merged nationwide case-based electronic health data registries: live birth, vaccination, hospitalization and mortality. Children born in 2010 and 2011 were followed from two moths of age for a period of two years. Using four different case definitions of pneumonia hospitalization and/or mortality (all-cause and pneumonia related deaths), all cases and four randomly selected matched controls per case were selected. Controls were matched to cases on analysis time. Vaccination status was then assessed. Vaccine effectiveness (VE) was estimated using conditional logistic regression. RESULTS: There were a total of 497,996 children in the 2010 and 2011 Chilean live-birth cohorts. PCV10 VE was 11.2% (95%CI 8.5-13.6) when all pneumonia hospitalizations and deaths were used to define cases. VE increased to 20.7 (95%CI 17.3-23.8) when ICD10 codes used to denote viral pneumonia were excluded from the case definition. VE estimates on pneumonia deaths and all-cause deaths were 71.5 (95%CI 9.0-91.8) and 34.8 (95% CI 23.7-44.4), respectively. CONCLUSION: PCV10 vaccination substantially reduced the number of hospitalizations due to pneumonia and deaths due to pneumonia and to all-causes over this study period. Our findings also reinforce the importance of having quality health information systems for measuring VE.
Assuntos
Vacinas Pneumocócicas/farmacologia , Pneumonia Pneumocócica/prevenção & controle , Estudos de Casos e Controles , Pré-Escolar , Chile/epidemiologia , Estudos de Coortes , Feminino , Humanos , Programas de Imunização , Esquemas de Imunização , Lactente , Recém-Nascido , Modelos Logísticos , Masculino , Morbidade , Programas Nacionais de Saúde , Vacinas Pneumocócicas/administração & dosagem , Pneumonia Pneumocócica/epidemiologia , Pneumonia Pneumocócica/mortalidade , Sistema de Registros , Resultado do Tratamento , Vacinas Conjugadas/administração & dosagem , Vacinas Conjugadas/farmacologiaRESUMO
The aim of this study was to evaluate the impact of PCV10 pneumococcal vaccine on mortality from pneumonia in children less than one year of age in Santa Catarina State, Brazil, comparing the four years prior and the four years subsequent to the vaccine's introduction in 2010. This ecological study used data from the Mortality Information System and vaccination coverage of children less than one year. Data were grouped by municipalities of residence and regions. Average mortality from pneumonia in children under one year decreased from 29.69 to 23.40 per 100,000, comparing 2006-2009 and 2010-2013, or a reduction of 11%. However there were differences between regions with a drop in mortality (Grande Florianópolis, Sul, Planalto Norte, and Nordeste) and others with an increase in the annual rates (Oeste, Itajaí, and Serra). In short, the state as a whole showed 11% reduction in mortality from pneumonia in children less than one year of age, four years after implementing routine PCV10 vaccination in the National Immunization Program, but with heterogeneous effects when comparing regions of the state.
Assuntos
Vacinas Pneumocócicas/administração & dosagem , Pneumonia Pneumocócica/mortalidade , Pneumonia Pneumocócica/prevenção & controle , Brasil/epidemiologia , Humanos , Programas de Imunização , Lactente , Recém-Nascido , Pneumonia Pneumocócica/imunologia , VacinaçãoRESUMO
Introducción: El Streptococcus pneumoniae (S. pneumoniae), también denominado neumococo, es una de las principales bacterias asociadas a mortalidad en menores de 2 años, con una incidencia de morbimortalidad variable de acuerdo a la demografía y exposición a factores protectores o de riesgo. Objetivo: Caracterizar los pacientes fallecidos por enfermedad neumocóccica invasiva (ENI) entre el 2008-2014 en la población infantil de 8 instituciones de salud en Bogotá, Colombia. Pacientes y método: Estudio observacional descriptivo tipo serie de casos, en pacientes fallecidos por ENI, mayores de 28 días hasta los 18 años, en 8 instituciones de tercer nivel de atención en Bogotá, Colombia. Periodo del estudio del 1 de enero de 2008 al 15 de enero de 2014. Tamaño de la muestra: 239 pacientes. Resultados: Se revisaron 239 casos registrados de ENI, presentando una mortalidad del 7,5% (n = 18). La edad promedio de los pacientes que fallecieron fue de 43,7 meses, con un rango de edad entre 2 y 176 meses (14 años); el 66% de los casos era de sexo masculino. Se identificaron serotipos en 8 pacientes, encontrando: 6A, 6B, 10A, 14, 18C, 23B, 23F, 35B. La presentación clínica más frecuente de los casos de mortalidad fue meningitis con el 33% (6 casos), seguida por bacteriemia sin foco en el 28% (5 casos) y neumonía con el 27% (5 casos). Se presentaron situaciones clínicas combinadas como neumonía y meningitis en el 11% (2 casos). Dos de los pacientes tenían factores de riesgo para ENI claramente documentados (asplenia y enfermedad respiratoria crónica). Conclusiones: La mortalidad por ENI es especialmente alta en los menores de 2 años y en pacientes de sexo masculino, especialmente cuando presenta foco meníngeo (44%). La serotipificación no fue posible en todos los pacientes fallecidos, ya que no se envió la cepa aislada al Instituto Nacional de Salud. Se requiere una vigilancia continua y sistemática para evaluar el impacto de la vacunación y las posibles modificaciones en el patrón de presentación de la enfermedad.
Introduction: Streptococcus pneumoniae (S. pneumoniae), also known as pneumococcus, is one of the main bacteria associated with mortality in children under 2 years of age, with a morbidity and mortality incidence that varies according to demographics and exposure to risk, or protective factors. Objective: To describe the child mortality due to invasive pneumococcal disease (IPD) between 2008 -2014 (6 years), in 8 Medical Centres in Bogotá, Colombia. Patients and method: Descriptive observational case series of patients who died of IPD, aged 28 days to 18 years, in 8 tertiary care institutions in Bogota, Colombia. The study period was from 1 January 2008 to 15 January 2014. Sample size: 239 patients. Results: A total of 239 registered cases of IPD were reviewed, showing a mortality of 8% (n 18). The mean age of patients that died was 43.7 months, with an age range from 2 to 176 months (14 years), with 66% of the cases being male. Serotypes were identified in 8 patients, finding: 6A, 6B, 10A, 14, 18C, 23B, 23F, and 35B. The most common clinical presentation of the cases was meningitis with mortality of 33% (6 cases), followed by bacteraemia without focus in 28% (5 cases), and pneumonia with 27% (5 cases). Combined clinical situations were presented, such as pneumonia and meningitis in 11% (2 cases). Two of the patients had clearly documented risk factors for IPD (asplenia and chronic respiratory disease). Conclusions: IPD mortality is particularly high in children under 2 years in male patients, especially when presented with a meningeal focus (44%). Serotyping was not possible in all patients who died, since no strain isolated was sent to the National Institute of Health. Continuous and systematic vigilance is required to evaluate the impact of vaccination and possible changes in the pattern of presentation of disease.
Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Pneumonia Pneumocócica/mortalidade , Streptococcus pneumoniae/isolamento & purificação , Bacteriemia/mortalidade , Meningite Pneumocócica/mortalidade , Pneumonia Pneumocócica/epidemiologia , Sorotipagem , Fatores Sexuais , Incidência , Estudos Retrospectivos , Fatores de Risco , Bacteriemia/microbiologia , Bacteriemia/epidemiologia , Colômbia/epidemiologia , Meningite Pneumocócica/epidemiologiaRESUMO
INTRODUCTION: Streptococcus pneumoniae (S. pneumoniae), also known as pneumococcus, is one of the main bacteria associated with mortality in children under 2 years of age, with a morbidity and mortality incidence that varies according to demographics and exposure to risk, or protective factors. OBJECTIVE: To describe the child mortality due to invasive pneumococcal disease (IPD) between 2008 -2014 (6 years), in 8 Medical Centres in Bogotá, Colombia. PATIENTS AND METHOD: Descriptive observational case series of patients who died of IPD, aged 28 days to 18 years, in 8 tertiary care institutions in Bogota, Colombia. The study period was from 1 January 2008 to 15 January 2014. SAMPLE SIZE: 239 patients. RESULTS: A total of 239 registered cases of IPD were reviewed, showing a mortality of 8% (n 18). The mean age of patients that died was 43.7 months, with an age range from 2 to 176 months (14 years), with 66% of the cases being male. Serotypes were identified in 8 patients, finding: 6A, 6B, 10A, 14, 18C, 23B, 23F, and 35B. The most common clinical presentation of the cases was meningitis with mortality of 33% (6 cases), followed by bacteraemia without focus in 28% (5 cases), and pneumonia with 27% (5 cases). Combined clinical situations were presented, such as pneumonia and meningitis in 11% (2 cases). Two of the patients had clearly documented risk factors for IPD (asplenia and chronic respiratory disease). CONCLUSIONS: IPD mortality is particularly high in children under 2 years in male patients, especially when presented with a meningeal focus (44%). Serotyping was not possible in all patients who died, since no strain isolated was sent to the National Institute of Health. Continuous and systematic vigilance is required to evaluate the impact of vaccination and possible changes in the pattern of presentation of disease.
Assuntos
Bacteriemia/mortalidade , Meningite Pneumocócica/mortalidade , Pneumonia Pneumocócica/mortalidade , Streptococcus pneumoniae/isolamento & purificação , Adolescente , Bacteriemia/epidemiologia , Bacteriemia/microbiologia , Criança , Pré-Escolar , Colômbia/epidemiologia , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Meningite Pneumocócica/epidemiologia , Pneumonia Pneumocócica/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Sorotipagem , Fatores SexuaisRESUMO
O objetivo deste trabalho foi avaliar o impacto da vacina pneumocócica PCV10 na redução da mortalidade por pneumonia em crianças menores de um ano, em Santa Catarina, Brasil, considerando os quatro anos antes versusquatro anos após a introdução da vacina em 2010. Estudo com delineamento ecológico, realizado com dados do Sistema de Informações sobre Mortalidade e das coberturas vacinais em menores de um ano de idade. Os dados foram agrupados por município de residência e macrorregião. A taxa média de mortalidade por pneumonia em menores de um ano no período 2006-2009 versus2010-2013 diminuiu de 29,69 para 23,40 por 100 mil, uma redução de 11%. Porém, observa-se uma divisão entre regiões com redução (Grande Florianópolis, Sul, Planalto Norte e Nordeste) e outras com aumento do gradiente das taxas anuais (Oeste, Itajaí e Serra). No estado, verificou-se uma redução média da taxa de mortalidade, por pneumonia em menores de um ano, de 11% após quatro anos da implantação da vacina como rotina no Programa Nacional de Imunizações, porém com efeitos heterógenos entre as regiões.
The aim of this study was to evaluate the impact of PCV10 pneumococcal vaccine on mortality from pneumonia in children less than one year of age in Santa Catarina State, Brazil, comparing the four years prior and the four years subsequent to the vaccine's introduction in 2010. This ecological study used data from the Mortality Information System and vaccination coverage of children less than one year. Data were grouped by municipalities of residence and regions. Average mortality from pneumonia in children under one year decreased from 29.69 to 23.40 per 100,000, comparing 2006-2009 and 2010-2013, or a reduction of 11%. However there were differences between regions with a drop in mortality (Grande Florianópolis, Sul, Planalto Norte, and Nordeste) and others with an increase in the annual rates (Oeste, Itajaí, and Serra). In short, the state as a whole showed 11% reduction in mortality from pneumonia in children less than one year of age, four years after implementing routine PCV10 vaccination in the National Immunization Program, but with heterogeneous effects when comparing regions of the state.
El objetivo de este estudio fue evaluar el impacto de la PCV10 en la reducción de mortalidad por neumonía en niños menores de un año en Santa Catarina, Brasil, teniendo en cuenta los cuatro años anteriores, frente a los cuatro años posteriores a la introducción de la vacuna en 2010. Este estudio ecológico se hizo con datos del Sistema de Informaciones sobre Mortalidad y cobertura de vacunación en niños menores de un año de edad. Los datos se agruparon según el lugar de residencia y región. La tasa media de mortalidad por neumonía en niños menores de un año en el período 2006-2009, en comparación con 2010-2013, disminuyó de 29,69 a 23,40 por 100.000 habitantes, una reducción del 11%. Sin embargo, hay una división entre las regiones con la reducción (Florianópolis, Sur, Norte y Nordeste Meseta) y otra con el aumento del gradiente de tasas anuales (West, Itajaí y Serra). En el estado hubo una reducción media de mortalidad por neumonía en niños menores de un año de un 11%, tras cuatro años de aplicación de la vacuna en el Programa Nacional de Inmunización, pero con efectos heterogéneos entre regiones.
Assuntos
Humanos , Lactente , Recém-Nascido , Vacinas Pneumocócicas/administração & dosagem , Pneumonia Pneumocócica/mortalidade , Pneumonia Pneumocócica/prevenção & controle , Brasil/epidemiologia , Programas de Imunização , Pneumonia Pneumocócica/imunologia , VacinaçãoRESUMO
Streptococcus pneumoniae is a major aetiological agent of pneumonia worldwide, as well as otitis media, sinusitis, meningitis and sepsis. Recent reports have suggested that inflammation of lungs due to S. pneumoniae infection promotes bacterial dissemination and severe disease. However, the contribution of anti-inflammatory molecules to the pathogenesis of S. pneumoniae remains unknown. To elucidate whether the production of the anti-inflammatory cytokine interleukin-10 (IL-10) is beneficial or detrimental for the host during pneumococcal pneumonia, we performed S. pneumoniae infections in mice lacking IL-10 (IL-10(-/-) mice). The IL-10(-/-) mice showed increased mortality, higher expression of pro-inflammatory cytokines, and an exacerbated recruitment of neutrophils into the lungs after S. pneumoniae infection. However, IL-10(-/-) mice showed significantly lower bacterial loads in lungs, spleen, brain and blood, when compared with mice that produced this cytokine. Our results support the notion that production of IL-10 during S. pneumoniae infection modulates the expression of pro-inflammatory cytokines and the infiltration of neutrophils into the lungs. This feature of IL-10 is important to avoid excessive inflammation of tissues and to improve host survival, even though bacterial dissemination is less efficient in the absence of this cytokine.
Assuntos
Interleucina-10/genética , Infiltração de Neutrófilos/imunologia , Neutrófilos/imunologia , Pneumonia Pneumocócica/imunologia , Streptococcus pneumoniae/imunologia , Animais , Carga Bacteriana/genética , Carga Bacteriana/imunologia , Encéfalo/microbiologia , Inflamação/imunologia , Interferon gama/biossíntese , Interleucina-10/biossíntese , Interleucina-10/imunologia , Interleucina-1beta/biossíntese , Pulmão/imunologia , Pulmão/microbiologia , Pulmão/patologia , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , Pneumonia Pneumocócica/mortalidade , Baço/microbiologia , Fator de Necrose Tumoral alfa/biossíntese , Fator de Necrose Tumoral alfa/imunologiaRESUMO
AIMS: Bacteremic pneumococcal pneumonia (BPP) is a severe condition. To evaluate seasonal distribution, mortality, serotype frequencies, antimicrobial susceptibility, and different severity scores among patients with BPP. PATIENTS AND METHODS: Patients were identified by laboratory data and restricted to adulthood. Standard methods were used for serotyping and antimicrobial susceptibility. Risk factors were analyzed by univariate and multivariate methods. Severity scores (APACHE II, CURB-65 and CAP PIRO) were compared using ROC curves. RESULTS: Sixty events of community-acquired BPP occurred between 2005 and 2010. A seasonal pattern was detected. Mean age was 72.1 years old (81.4% >60 years). All had a predisposing factor. Previous influenza (3.3%) or pneumococcal immunization (1.7%) was infrequent. Admission to critical units was required by 51.7%. Twenty-two serotypes were identified among 59 strains. Only one strain had intermediate resistance to penicillin (1.7%). In-hospital mortality reached 33.3%. Multivariate analysis identified a CAP PIRO score>3 (OR 29.7; IC95 4.7-187), age >65 years (OR 42.1; IC95 2.2-796), and a platelet count<100,000/μL (OR 10.9; IC95 1.2-96) as significant independent factors associated with death. ROC curve analysis did not reveal statistical differences between the three severity scores to predict death (AUC 0.77-0.90). The prognostic yield for all of them was limited (Positive Likelihood Ratio: 1.5-3.8). CONCLUSIONS: BPP had a high case-fatality rate in this group of adult patients with no association to resistant isolates, and a low immunization record. Three independent factors were related to death and the prognostic yield of different severity scores was low. .