Bacterial pneumonia was implicated in 43% of all community-based, unexpected infectious disease deaths during a recent 2-year period in one Canadian province, according to retrospective study findings published in Open Forum Infectious Diseases.
“Although sudden expected deaths from cardiac diseases have been well-studied, there is very little prior research on sudden, unexpected deaths from infectious diseases,” Nick Daneman, MD, FRCPC, MSc, a scientist with the Sunnybrook Research Institute in Toronto, told Infectious Disease News. “In a 2-year study of all coroner cases involving sudden unexpected deaths in Ontario, Canada (population 14 million), we found more than 400 cases caused by a variety of infectious syndromes and pathogens, of which the most common were bacterial pneumonia and Staphylococcus aureus, respectively.”
Daneman and colleagues conducted the population-based, retrospective cohort study to determine patient, pathogen and disease-related factors surrounding unexpected infectious deaths. They collected patient-related information, infection-related information and circumstances around death from all community-based, unexpected infectious deaths in Ontario between January 2016 and December 2017.
Of the 7,506 cases of unexpected deaths that were identified, 6% (n = 418) were caused by infectious diseases, Daneman and colleagues found. Of those, 43% were the result of bacterial pneumonia, making it the most common infectious syndrome. The second most common cause was disseminated infection with no clear focus, which represented 12% of cases, the researchers reported. Additionally, 10%, 6% and 5% of deaths were caused by peritonitis, myocarditis and pyelonephritis, respectively.
Daneman and colleagues identified a pathogen in 50% (n = 210) of cases, the most common being S. aureus, Streptococcus pneumoniae and pyogenes, Klebsiella species and Escherichia coli.
Prodromal symptoms before death were reported for 68% of patients, and they lasted for a median length of 1 day. But only about one-third of patients had a recent health care exposure before death, the researchers reported.
“We need to develop upstream strategies to prevent these deaths, such as vaccines, and public education about early warning signs of sepsis,” Daneman said. – by Marley Ghizzone
Disclosures: Daneman reports receiving funding from the Canadian Institutes of Health Research Clinician Scientist Salary Award, although no direct funding or grants were used for this study. All other authors report no relevant financial disclosures.