• Yasuyoshi Washio, Akihiro Ito, Shogo Kumagai, Tadashi Ishida, and Akio Yamazaki.
• Department of Respiratory Medicine, Saiseikai Fukuoka General Hospital, 1-3-46 Tenjin, Chuo-ku, Fukuoka, 810-0001, Japan. yasuyoshiwashio@gmail.com.
• BMC Pulm Med. 2018 Jan 30; 18 (1): 24.

BackgroundPneumococcal pneumonia causes high morbidity and mortality among adults. This study aimed to identify risk factors for bacteremic pneumococcal pneumonia, and to construct a prediction model for the development of bacteremia in patients with community-acquired pneumococcal pneumonia.MethodsWe retrospectively analyzed data from patients hospitalized with community-acquired pneumococcal pneumonia between April 2007 and August 2015. Logistic regression models were applied to detect risk factors for pneumococcal bacteremia, and a receiver operating characteristic curve was used to devise a prediction model.ResultsBased on the results of sputum cultures, urine antigen tests, and/or blood cultures, 389 patients were diagnosed with pneumococcal pneumonia, 46 of whom had bacteremia. In the multivariate analysis, age < 65 years, serum albumin level < 3.0 g/dL, need for intensive respiratory or vasopressor support (IRVS), and C-reactive protein level > 20 mg/dL were identified as independent risk factors for the development of pneumococcal bacteremia. The bacteremia prediction score based on receiver operating characteristic curve analysis had a sensitivity of 0.74 and a specificity of 0.78 in patients with two risk factors. The area under the receiver operating characteristic curve was 0.77 (95% confidence interval (CI), 0.70-0.85).ConclusionsAge < 65 years, hypoalbuminemia, IRVS, and high C-reactive protein level on admission are independent risk factors for the development of bacteremia in patients with community-acquired pneumococcal pneumonia. A prediction model based on these four risk factors could help to identify patients with community-acquired pneumococcal pneumonia at high risk of developing bacteremia; this can be used to guide antibiotic choices.Trial RegistrationUMIN-CTR UMIN 000004353 . Registered 7 October 2010. Retrospectively registered.

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