Objective:

Analyse differences in clinical presentation and outcome between bacteraemic pneumococcal community-acquired pneumonia (B-PCAP), and SARS-CoV-2 pneumonia.


Methods:

Observational multicenter study conducted on patients hospitalized for B-PCAP between 2000-2020 and SARS-CoV-2 pneumonia during 2020. We compared 30-day survival, predictors of mortality and intensive care unit (ICU) admission.


Results:

We included 663 B-PCAP and 1561 SARS-CoV-2 pneumonia. B-PCAP patients had higher severity, ICU admission and more complications. SARS-CoV-2 pneumonia patients had higher in-hospital mortality (10.8%vs6.8%, p 0.004). Among ICU patients, need for invasive mechanical ventilation (69.7%vs36.2%, p<0.001) and mortality were higher in SARS-CoV-2 pneumonia. In B-PCAP, our predictive model related mortality to systemic complications (hyponatremia, septic shock, neurological complications), lower respiratory reserve or tachypnoea; whereas chest pain and purulent sputum were protective. In SARS-CoV-2, mortality was related to previous liver and cardiac disease, advanced age, altered mental status, tachypnoea, hypoxemia, bilateral involvement, pleural effusion, septic shock, neutrophilia, and high blood urea nitrogen; in contrast, ≥7 days of symptoms was a protective factor. In-hospital mortality occurred earlier in B-PCAP.


Conclusions:

Although B-PCAP was associated with higher severity and ICU rate, SARS-CoV-2 pneumonia-related mortality was higher and occurred later. New prognostic scales and more effective treatments are needed for SARS-CoV-2 pneumonia.


Keywords:

Bacteraemic pneumococcal pneumonia; Community acquired pneumonia; Mortality; Process of care; SARS-CoV-2; Survival.

Source