Comparison of Clinical Characteristics of Pneumococcal and non-Pneumococcal Streptococcal Pneumonia

Yu Mi Jo; Joon Young Song; Won Suk Choi; Jung Yeon Heo; Ji Youn Noh; Woo Joo Kim; Hee Jin Cheong

doi:10.3947/ic.2010.42.4.223

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Jo, Song, Choi, Heo, Noh, Kim, and Cheong: Comparison of Clinical Characteristics of Pneumococcal and non-Pneumococcal Streptococcal Pneumonia

Original Article

Infection & Chemotherapy

Infection & Chemotherapy 2010; 42(4): 223-229.

Published online: 30 August 2010

DOI: https://doi.org/10.3947/ic.2010.42.4.223

Comparison of Clinical Characteristics of Pneumococcal and non-Pneumococcal Streptococcal Pneumonia

Yu Mi Jo, Joon Young Song, Won Suk Choi, Jung Yeon Heo, Ji Youn Noh, Woo Joo Kim, Hee Jin Cheong

Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.

Correspondence to Hee-Jin Cheong, M.D., Ph.D. Division of Infectious Disease, Department of Internal Medicine, Korea University College of Medicine, 97 Guro Dong-gil, Guro-gu, Seoul 152-703, Korea. Tel: +82-2-2626-3050, Fax: +82-2-2626-1105, heejinmd@medimail.co.kr

Received 10 May 2010 Revised 10 August 2010 Accepted 11 August 2010

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

Although Pneumococcal (SPN) pneumonia is the most common cause of community-acquired pneumonia, non-pneumococcal streptococcal (NSPN) pneumonia is also frequently reported. However, there are insufficient data on characteristics of NSPN pneumonia which makes it difficult to decide treatment plans or to assess the prognosis.

Materials and Methods

Between March 2002 and February 2009, medical records including clinical and epidemiological data on patients aged ≥18 years with community-acquired streptococcal pneumonia were reviewed retrospectively. Clinical characteristics were compared between community-acquired NSPN pneumonia and SPN pneumonia.

Results

During the 7 year study periods, 248 patients were hospitalized with community-acquired streptococcal pneumonia and 30 of them had NSPN pneumonia. There were 12 cases of Streptococcus constellatus, 7 cases of S. anginosus, 4 cases of S. mitis, 3 cases of S. pyogenes, 2 cases of S. oralis, 1 case of S. alactolyticus and 1 case of S. agalactiae. There was no difference in percentage of patients with a chronic underlying disease between SPN and NSPN pneumonia groups. The most common was chronic obstructive pulmonary disease (SPN 29.8%, NSPN 16.7%) followed by diabetes mellitus (SPN 22.0%, NSPN 13.3%). Bacteremia (SPN 7.3%, NSPN 20.0%, P=0.04) and empyema (SPN 1.4%, NSPN 53.3%, P<0.001) were more common in NSPN pneumonia. However, there was no significant difference in the CURB-65 pneumonia severity score and 30-day mortality between the two groups. According to multivariate analysis results, the significant risk factor for NSPN pneumonia was the history of frequent alcohol drinking (Adjusted OR 3.81, 95% CI 1.36 to 10.67).

Conclusion

Pneumonia caused by NPSN is more commonly accompanied by bacteremia and empyema compared to SPN pneumonia, but there was no difference in the 30-day mortality between the two groups. NSPN pneumonia should be considered if a patient with a history of chronic alcoholism presents with pneumonia and pleural effusion, especially when Gram positive diplococci is seen in the sputum Gram stain.

Keywords: Community-acquired pneumonia, Pneumococcal pneumonia, Streptococcus

Figures and Tables

Figure 1

Annual cases of Streptococcal pneumonia.

SPN, Pneumococcal pneumonia; NSPN, Non-pneumococcal streptococcal pneumonia.

Table 1

Baseline Characteristics of Patients with Streptococcal Pneumonia

^{a, d}Some patients had more than one conditions

^bIncluding hematologic malignancy

^cCurrent immnune suppressive therapy including radiation, systemic steroids or chemotherapy

^eAlcohol drinking more than five times a week

Table 2

Clinical Presentation and Outcome of Streptococcal Pneumonia

Table 3

Culture Results and Pleural fluid analysis in Streptococcal Pneumonia

SD, standard deviation; LDH, lactate dehydrogenase

^aIn five cases, SPN cultured in both sputum and blood

^bIn one case, SPN cultured in both sputum and pleural fluid

Table 4

Drug Susceptibility of Streptococcus isolated from Patients with Streptococcal Pneumonia (n=248)

^aIf the MIC criteria have only susceptible range, strains yielding results suggestive of a "nonsusceptible" category, we assumed the results as resistant.

^bMICs of SPN: penicillin resistance MIC ≥2 µg/mL, erythromycin resistance MIC ≥1 µg/mL, cefotaxime resistance MIC ≥4 µg/mL, vancomycin susceptible MIC ≤1 µg/mL, levofloxacin resistance MIC ≥8 µg/mL, TMP/SMX resistance MIC ≥4/76 µg/mL

^cMICs of Streptococcus spp. Viridans Group including SMG Group, penicillin resistance MIC ≥4 µg/mL

MICs of Streptococcus spp. β-hemolytic Group: penicillin susceptible MIC ≤0.12 µg/mL, cefotaxime susceptible MIC ≤0.5 µg/mL

Otherwise same as SPN

^dMIC results of cefotaxime were available in 74 cases of SPN pneumonia and 14 cases of NSPN pneumonia

^eTrimethoprim/sulfamethoxazole

Table 5

Univariate and Multivariate Analysis for Risk Factors Associated Non-Pneumococcal Streptococcal Pneumonia

^aBlank result means excluded variables

^bAlcohol drinking more than five times a week

^{c, f}Some patients had more than one conditions

^dIncluding hematologic malignancy

^eCurrent immnune suppressive therapy including radiation, systemic steroids or chemotherapy

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