Streptococcus pneumoniae serotype could determine long-term survival after bacteremic pneumococcal pneumonia

<bold>Background:</bold> Bacteremic pneumococcal pneumonia (BP-CAP) may have an impact on long-term survival beyond the initial episode; however, it is not known whether the infecting serotype could be related to an increase in long-term mortality. Our objective was to determine if the serotype causing bacteremic pneumococcal pneumonia has a role in long-term prognosis. <bold>Methods:</bold> We analyzed data from a prospective study of patients with BP-CAP. Clinical and analytical data, and microbiological characteristics of Streptococcus pneumoniae from survivors of an episode of BP-CAP were analyzed during a one-year follow-up. <bold>Results:</bold> We analyzed 212 patients with bacteremic pneumococcal pneumonia in which 30-day mortality was 32.7% (69 patients). Survivors (143 patients) were followed up during the first year after the initial episode, and mortality was 15.4% (22 patients) (median time to death: 128.5 days, IQR: 71.5-221.8). The risk factors independently associated with mortality were: age over 70 years [OR 3.20 (95% CI 1.11-9.21); p=0.031], the presence of active neoplasia [OR 8.72 (95% CI 2.64-28.83); p<0.01] and COPD [OR 3.56 (95% CI 1.17-10.81); p=0.025], and the infection by serotype 3 [OR 4.96 (95% CI 1.42-17.32), p=0.012]. <bold>Conclusions:</bold> 1. The impact of BP-CAP on long-term survival is seen far beyond an initial acute episode. 2. During a one-year follow-up, long-term mortality was significantly higher among patients infected by pneumococcal serotype 3 compared to other serotypes. 3. The effect of pneumococcal vaccination in preventing these late events still needs to be elucidated.