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. 2013 Oct 8;8(10):e71924.
doi: 10.1371/journal.pone.0071924. eCollection 2013.

Factors influencing early and late mortality in adults with invasive pneumococcal disease in Calgary, Canada: a prospective surveillance study

Leah J Ricketson  1 , Alberto Nettel-Aguirre, Otto G Vanderkooi, Kevin B Laupland, James D Kellner
Affiliations

Factors influencing early and late mortality in adults with invasive pneumococcal disease in Calgary, Canada: a prospective surveillance study

Leah J Ricketson et al. PLoS One. .

Abstract

Background: Invasive pneumococcal disease continues to be an important cause of mortality. In Calgary, 60% of deaths occur within 5 days of presenting to hospital. This proportion has not changed since before the era of penicillin. The purpose of this study was to investigate what factors may influence death within 5 days of presentation with pneumococcal disease.

Methods and findings: Demographic and clinical data from the CASPER (Calgary Area Streptococcus pneumoniae Epidemiology Research) study on 1065 episodes of invasive pneumococcal disease in adults (≥18 years) from 2000 to 2010 were analyzed. Adjusted multinomial regression was performed to analyze 3 outcomes: early mortality (<5 days post-presentation), late mortality (5-30 days post-presentation), and survival, generating relative risk ratios (RRR). Patients with severe disease had increased risk of early and late death. In multinomial regression with survivors as baseline, the risk of early death increased in those with a Charlson index ≥2 (RRR: 6.3, 95% CI: 1.8-21.9); the risk of late death increased in those with less severe disease and a Charlson ≥2 (RRR: 6.1, 95% CI: 1.4-27.7). Patients who never received appropriate antibiotics had 5.6X (95% CI: 2.4-13.1) the risk of early death. Risk of both early and late death increased by a RRR of 1.3 (95% CI: 1.2-1.4) per 5-year increase in age. In multinomial regression, there were no significant differences in the effects of the factors tested between early and late mortality.

Conclusions: Presenting with severe invasive pneumococcal disease, multiple comorbidities, and older age increases the risk of both early and late death. Patients who died early often presented too late for effective antibiotic therapy, highlighting the need for an effective vaccine.

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Conflict of interest statement

Competing Interests: The authors have read the journal's policy and have the following conflicts: OGV has performed contract vaccine clinical trials for both Wyeth/Pfizer and GlaxoSmithKline, and has received investigator initiated research grants from Wyeth/Pfizer and has been on advisory boards for GlaxoSmithKline and Novartis. KBL has received unrestricted research grants and speakers honoraria from Merck Canada, GlaxoSmithKline, and Wyeth/Pfizer. JDK has received unrestricted research grants from Wyeth/Pfizer, and research contracts from Wyeth/Pfizer and GlaxoSmithKline. JDK has been on advisory boards for Wyeth/Pfizer and GlaxoSmithKline, and has received a speaker’s honoraria from Wyeth/Pfizer. This does not alter the authors' adherence to all the PLOS ONE policies on sharing data and materials. LJR and AN have no competing interests to declare.

Figures

Figure 1
Figure 1. Classification of Antibiotic Appropriateness Accounting for Isolate Susceptibilities.
Figure 2
Figure 2. Outcomes for Eligible Cohort of Calgary Adults with IPD from 2000-2010.
See this image and copyright information in PMC

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