Bacteremic pneumococcal pneumonia in 45 immunocompromised hospitalized adults

Abstract

The presence of bacteremia during a pneumococcal pneumonia is a sign of bad prognosis. To report a clinical experience with bacteremic pneumococcal pneumonia. We reviewed the clinical and laboratory data from 45 adults (36 male, aged 17 to 97 years) with community acquired pneumonia (CAP) and Streptococcus pneumoniae bacteremia, hospitalized between January 1997 and August 2002 at the Puerto Montt Hospital (Southern Chile). Eighty four percent of patients bad underlying aggravating conditions, mainly alcoholism (40%), chronic obstructive lung disease (17.8%) and renal failure (17.8%). Seven percent were homeless. Fever, cough, dyspnea and sputum were the most common presenting symptoms. Five patients had pleural involvement. Four strains (8.9%) of S. pneumoniae had diminished susceptibility to penicillin. Nine patients died (case-fatality rate of 20%), but mortality was attributed to pneumonia in only three of them. Main factors associated with a higher mortality were renal failure, absence of cough, an arterial pH < 7.3 on admission, ICU hospitalization, shock, mechanical ventilation and an APACHE score > 16. The high death rate of these patients could be explained mainly by underlying conditions. ICU management and higher cost preventive measures could reduce this rate.