Influence Of The Infecting Serotype On The Development Of Complications In Bacteriemic Pneumococcal Pneumonia With High Inflammatory Response

Background: An excessive inflammation during infection could develop complications but it is not known if the infectious pathogen could determine different outcomes in spite of the inflammatory response. We aimed to assess the influence of the infecting serotype on the development of complications during bacteremic pneumococcal pneumonia (BP-CAP) in a population with a high inflammatory response. Methods: Analysis of a prospective, multicenter study of patients with BP-CAP. High inflammatory level was defined for CRP> 15 mg / dl. The following complications were analyzed: ICU admission, septic shock, systemic, respiratory and cardiovascular complications. The t-student9s and X2 test were used for the analysis. Results: From 578 patients with BP-CAP, we analyzed those with high inflammatory response: 463 cases (80.1%), 97 of them (21%) were infected with serotype 3. CRP values were similar between serotype 3 and the others [38.7 (12.9) vs 35.9 (12.9); p = 0.063]. Patients infected with serotype 3 showed more septic shock (36.1% vs. 16.9%; p <0.01), ICU admission (45.4% vs 27.1%; p <0.01), respiratory (77.3% vs. 51.1%; p <0.01), systemic (80.4% vs 57.1%; p <0.01) and cardiovascular complications (41.2% vs. 21%; p <0.01) compared to other serotypes. Mortality was similar between groups. Patients who required ICU admission [39.1 (14.5) vs 35.3 (12.2); p=0.004] or presented systemic complications [37.8 (13.5) vs 34.3 (11.8); p=0.004] showed greater values of CRP. Conclusions: In a population of patients with BP-CAP with a high inflammatory level, the presence of serious complications is associated with the infecting serotype, specifically with serotype 3.