Pneumococcal Bacteremia in Childhood: A 6-Year Experience in a Community Hospital

Abstract

To review the clinical and laboratory findings in children with pneumococcal bacteremia during a 6-year period between 1989 and 1995. Retrospective review of medical records identified from computer-generated blood culture records. Hurley Medical Center in Flint, Mich, a community teaching hospital affiliated with Michigan State University. Data concerning age, gender, race, clinical findings, laboratory features, nature of antibiotic therapy, source of bacteremia, and outcome were obtained from patient medical records. Most (68%) of the children with pneumococcal bacteremia were <2 years of age. About 50% of the cases of invasive pneumococcal disease in childhood occurred between February and May. Focal source of bacteremia was as follows: 11.5% had meningitis, 37% had pneumonia, 30% had otitis media, and 33% had no focal source. Overall, 60% of children were African-Americans, although in children with meningitis, whites were predominant (p<0.04). Leukocytosis was present in 81% and bandemia >1,500/microL was present in 53% of children. The overall mortality was 1.6% with a case fatality rate for meningitis of 14%. Penicillin resistance was found in 6.5% of pneumococcal isolates, although during 1 study year (1993), 17% of all pneumococcal isolates from all sources in the same hospital were found to be penicillin resistant. Clinical and laboratory findings seen in children with pneumococcal bacteremia at a community hospital are presented with a review of literature. Pneumococci isolated from sterile body sites were found to be less resistant to antibiotics compared with those isolated from nonsterile body sites.