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Permanent link (DOI): https://doi.org/10.7939/R39Z90P4M

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Identifying Prognostic Factors for Adverse Outcomes in Adults with Bacteremic Pneumococcal Pneumonia Open Access

Descriptions

Other title
Subject/Keyword
Smoking
Bacteremia
Mortality
Streptococcus
Pneumonia
Prognosis
Type of item
Thesis
Degree grantor
University of Alberta
Author or creator
Beatty, Jessica A
Supervisor and department
Eurich, Dean (Public Health)
Examining committee member and department
Sligl, Wendy (Medicine)
Sumit, Majumdar (Medicine)
Department
School of Public Health
Specialization
Epidemiology
Date accepted
2016-03-21T09:59:01Z
Graduation date
2016-06
Degree
Master of Science
Degree level
Master's
Abstract
Bacteremic pneumococcal pneumonia (BPP) is a severe form of invasive pneumonia that continues to cause significant morbidity and mortality worldwide, yet large-scale studies identifying prognostic factors for adverse outcomes in patients with BPP is significantly lacking. Furthermore, considerable knowledge gaps and conflicting results exist for even widely known prognostic factors for mortality such as smoking. Therefore, the first objective of this program of research was to identify prognostic factors associated with mortality and in-hospital complications in adult patients with BPP. This objective was achieved using a population-based cohort study composed of 1636 adults (≥18 years) with BPP hospitalized between 2000-2010 in Northern Alberta, Canada. The results indicated that both acid-suppressing drugs and guideline discordant antibiotic treatments are potentially modifiable prognostic factors. Furthermore, frailty (i.e. elderly, nursing home residents, or dementia patients), pneumonia severity, and high case fatality rate (CFR) serotypes were associated with an increased risk of morbidity and mortality, while prior pneumococcal vaccination was associated with a reduced risk. Paradoxically, current smoking was associated with reduce mortality in patients with BPP. Building on this result, the second objective of this research program was to examine whether differential acquisition of pneumococcal serotypes in smokers could potentially explain the influence on mortality. The results indicated that current smokers were more likely to be infected with low CFR pneumococcal serotypes compared to non-smokers, which may fully, or partially, explain the reduced mortality previously reported in studies involving patients with CAP. Collectively this research suggests that several modifiable prognostic factors exist in patients with BPP. Moreover, additional follow-up in patients who are frail following BPP may also be warranted. As this research is the first to suggest that differential acquisition of low CFR serotypes may explain the reduced mortality in smokers with pneumonia, further research is needed to confirm these findings and determine the usefulness of providing CFR data rapidly at the point of care.
Language
English
DOI
doi:10.7939/R39Z90P4M
Rights
This thesis is made available by the University of Alberta Libraries with permission of the copyright owner solely for the purpose of private, scholarly or scientific research. This thesis, or any portion thereof, may not otherwise be copied or reproduced without the written consent of the copyright owner, except to the extent permitted by Canadian copyright law.
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