Comparison of CAP CR− With Antibiotic and CAP CR− Without Antibiotic: Patient Characteristics, Conditions With Increased Risk of Invasive Pneumococcal Disease, History of Pneumonia, Vaccination Status, Symptoms on Inclusion and Clinical Examination, Follow-Up, and Data on Day 28
| Total N = 115 (100.0%) | CR−With Antibiotic Initiation n = 79 (68.7%) | CR−Without Antibiotic Initiation n = 36 (31.3%) | P Value | |
|---|---|---|---|---|
| Age at inclusion, y, median (IQR) | 57.0 (40.0-70.0) | 57.0 (40.0-70.0) | 57.5 (40.5-71.0) | .890 |
| Sex (female), No. (%) | 68 (59.1) | 45 (57.0) | 23 (63.9) | .543 |
| Antibiotics started before inclusion, No. (%) | 1 (0.9) | 1 (1.3) | 0 (0) | >.99 |
| CRB-65 score, No. (%) | ||||
| 0 | 61 (54.5) | 45 (57.7) | 16 (47.1) | .629 |
| 1 | 46 (41.1) | 29 (37.2) | 17 (50.0) | |
| 2 | 4 (3.6) | 3 (3.8) | 1 (2.9) | |
| 3 | 1 (0.9) | 1 (1.3) | 0 (0) | |
| CAP risk factors, No. (%) | ||||
| Risk factors for invasive pneumococcal infection (none)a | 89 (77.4) | 60 (75.9) | 29 (80.6) | .639 |
| Chronic respiratory disease (COPD, emphysema, other cause) | 9 (7.8) | 5 (6.3) | 4 (11.1) | .458 |
| Diabetes | 3 (2.6) | 3 (3.8) | 0 (0) | .551 |
| Chronic heart failure | 4 (3.5) | 3 (3.8) | 1 (2.8) | >.99 |
| History of pneumonia | 16 (13.9) | 11 (13.9) | 5 (13.9) | >.99 |
| Vaccination status, No. (%) | ||||
| Antipneumococcal | 8 (7.1) | 7 (9.1) | 1 (2.8) | .432 |
| Anti-influenza for previous season | 33 (29.5) | 27 (35.1) | 6 (17.1) | .073 |
| Anti-influenza for current or next season | 24 (21.2) | 16 (20.8) | 8 (22.2) | >.99 |
| Symptoms present at inclusion | ||||
| Cough, No. (%) | 113 (98.3) | 78 (98.7) | 35 (97.2) | .530 |
| Sputum, No. (%) | 68 (59.1) | 51 (64.6) | 17 (47.2) | .102 |
| Dyspnea, No. (%) | 46 (40.0) | 34 (43.0) | 12 (33.3) | .413 |
| Aches and pains, No. (%) | 76 (66.7) | 55 (70.5) | 21 (58.3) | .208 |
| Tiredness, No. (%) | 109 (94.8) | 78 (98.7) | 31 (86.1) | .011 |
| Chills/sweats, No. (%) | 66 (57.4) | 46 (58.2) | 20 (55.6) | .840 |
| Unilateral chest pain, No. (%) | 25 (21.7) | 16 (20.3) | 9 (25.0) | .628 |
| Headache, No. (%) | 47 (40.9) | 31 (39.2) | 16 (44.4) | .684 |
| Ear, nose, and throat symptoms (sore throat, colds, sinus pain, etc), No. (%) | 64 (55.7) | 50 (63.3) | 14 (38.9) | .017 |
| Fever reported by patient, No. (%) | 75 (65.8) | 52 (66.7) | 23 (63.9) | .833 |
| Digestive signs (nausea, vomiting, diarrhea, abdominal pain), No. (%) | 17 (14.8) | 13 (16.5) | 4 (11.1) | .577 |
| Confusion (altered mental state), No. (%) | 3 (2.6) | 3 (3.8) | 0 (0) | .551 |
| Duration of symptoms on the day of inclusion (days), median (IQR) | 4.0 (2.0-7.0) | 4.0 (2.0-7.0) | 3.0 (2.0-7.0) | .442 |
| Physical examination at inclusion | ||||
| Body temperature (°C), median (IQR) | 37.3 (37.0-38.0) | 37.3 (37.0-38.0) | 37.2 (36.6-37.8) | .166 |
| Heart rate (bpm), median (IQR) | 82.0 (71.0-95.0) | 86.0 (72.0-100.0) | 80.0 (70.0-88.0) | .024 |
| Respiratory rate (breaths/min), median (IQR) | 16.0 (15.0-20.0) | 17.0 (15.0-20.0) | 15.0 (14.0-17.5) | .001 |
| Systolic blood pressure (mm Hg), median (IQR) | 126.0 (120.0-136.0) | 128.5 (120.0-140.0) | 125.0 (112.5-135.0) | .348 |
| Diastolic blood pressure (mm Hg), median (IQR) | 80.0 (70.0-80.0) | 80.0 (70.0-80.0) | 80.0 (75.0-89.0) | .108 |
| SaO2 (%), median (IQR) | 97.0 (95.0-98.0) | 97.0 (94.5-98.0) | 97.0 (96.0-98.0) | .037 |
| Global impression of severity, No. (%) | 26 (22.8) | 21 (26.9) | 5 (13.9) | .153 |
| Auscultatory abnormalities compatible with CAP, No. (%) | ||||
| Crackles | 66 (57.4) | 48 (60.8) | 18 (50.0) | .313 |
| Wheezing | 25 (21.7) | 19 (24.1) | 6 (16.7) | .468 |
| Ronchi | 42 (36.5) | 31 (39.2) | 11 (30.6) | .410 |
| Decrease in breath sounds | 23 (20.0) | 16 (20.3) | 7 (19.4) | >.99 |
| Dullness on percussion | 5 (4.5) | 4 (5.1) | 1 (2.9) | >.99 |
| Duration of clinical evolution of the following symptoms, median (IQR) | ||||
| Fever (>38.5 °C) since beginning of symptoms (days) | 2.0 (0-4.0) | 2.0 (0-4.0) | 3.0 (0-4.0) | .991 |
| Fever (>38.5 °C) with antibiotics (days) | 0 (0-2.0) | 0 (0-2.0) | 0 (0) | .005 |
| Cough (days) | 10.0 (7.0-21.0) | 10.0 (7.0-21.0) | 10.0 (7.0-21.0) | .894 |
| Chest pain (days) | 0 (0-2.0) | 0 (0-3.0) | 0 (0-1.0) | .523 |
| Dyspnea (days) | 0 (0-10.0) | 3.0 (0-10.0) | 0 (0-6.0) | .038 |
| Tiredness with impact on daily activities (days) | 7.0 (3.0-14.0) | 7.0 (3.0-15.0) | 5.0 (2.0-10.0) | .229 |
| Tiredness without impact on daily activities (days) | 7.0 (0-16.0) | 7.0 (0-15.0) | 7.0 (0-20.0) | .793 |
| Hospitalization since initial consultation and day 28, No. (%) | 2 (1.9) | 1 (1.4) | 1 (2.9) | .549 |
bpm = beats per minute; CAP = community-acquired pneumonia; COPD = chronic obstructive pulmonary disease; CR− = chest radiography negative; CRB-65 = confusion, respiratory rate, blood pressure, age; CSF = cerebrospinal fluid; IQR = interquartile range; SaO2 = oxygen saturation of arterial blood.
↵a Risk factors for invasive pneumococcal infection according to the French vaccine schedule 2017: chronic respiratory disease (COPD, emphysema, chronic bronchitis, chronic pulmonary failure), asthma, chronic heart failure, nephrotic syndrome, asplenia or splenectomy (functional or anatomic asplenia), chronic liver disease, homozygous sickle cell disease, HIV infection, immunocompromising conditions (congenital immune deficiency, chemotherapy, immune modulators, corticosteroids, transplantation), diabetes mellitus, CSF leak, cochlear implant.14