Episodes Of Pneumococcal Bacteremia Research Articles

Clinical features and outcomes of pneumococcal bacteremia among children at a tertiary care hospital

Background: Invasive pneumococcal disease (IPD) has high mortality among children. Pneumococcal bacteremia is an important marker of IPD but has received limited attention in predicting the outcomes of illness. The aim of this study was to evaluate clinical features, focus of infection, and comorbid of pneumococcal bacteremia in a pediatric cohort at a tertiary care center in Karachi, Pakistan. Methods: Children aged 0–14 years admitted to the Aga Khan University Hospital with pneumococcal bacteremia were identified through a laboratory database. Demographic, clinical, and outcome data were obtained from patients' medical records. Data entry and analysis were carried out in MS Excel and SPSS version 19.0. Results: Forty (n = 40) episodes of pneumococcal bacteremia in 39 children were identified. The median age of the cohort was 2.5 (interquartile range 4.15–1.1) years; 30% (n = 12) of these were infants aged 0–12 months. The primary focus of infection was identified as pneumonia in 47.5% (n = 19) and meningitis in 7.5% (n = 3). The prevalence of occult bacteremia was 27.5% (n = 11). Outcomes of infection at hospital discharge were assessed in 31 patients as nine patients were either transferred out or left against advice. Of 31 patients, 6 (19.4%) died and 25 (80.6%) were discharged home. Associations with mortality included sepsis (P = 0.017) and absence of a focus (occult bacteremia) (P = 0.007). Conclusion: Sepsis and occult bacteremia (without an underlying focus) were associated with mortality. No association was found between choice of antibiotics administered, penicillin minimum inhibitory concentration, and poor outcome at discharge. Other factors such as comorbidities, immune status, and focus of infection play an important role in predicting the outcomes of pneumococcal bacteremia.

Pneumococcal bacteremia in a single center in Argentina

Objective: To determine the clinical and microbiologic characteristics of pneumococcal bacteremia at Sanatorio Mitre, Buenos Aires, Argentina. Methods: One-hundred-and-seven episodes of pneumococcal bacteremia were prospectively analyzed from 1993 to 1998. Demographics, clinical and microbiological variables were studied. Results: Eighty-one patients (76%) were adults and 26 children (24%). Most cases (98%) were acquired in the community. Seventy-nine patients (74%) had at least one underlying condition. The primary source of bacteremia was found in 91 patients (85%), the lungs being the most common source. Streptococcus pneumoniae was isolated from one sterile site other than the primary focus in 25 patients (23%). Eighty-five (79%) of the Streptococcus pneumoniae were susceptible to penicillin and 22 (21%) showed intermediate or high resistance to penicillin and 2% were additionally resistant to ceftriaxone. Initial antimicrobial therapy was appropriate in 95% of the cases. The overall mortality was 21%, however adults admitted to the intensive care unit (ICU) had higher mortality (81%). No patients under 14 years old died. Multivariate analysis showed that age and recovery of the organisms from a sterile site other than the primary focus were statistically significant predictors of mortality. Conclusion: Bacteremic pneumococcal infections continue to be an important worldwide problem causing morbidity and high mortality despite supportive care and appropriate antimicrobial therapy.

ANALYSIS OF 405 EPISODES OF PNEUMOCOCCAL BACTEREMIA IN ADULTS OVER A 15-YEAR PERIOD*

Background. HIV-infection and increasing drug resistance may influence the prognosis of pneumococcal bacteremia. We performed an observational cohort study to analyze the epidemiology, risk factors, and outcome for pneumococcal bacteremia during a 15-year period. Methods. Charts were reviewed from hospitalized adults at the University Hospital Basel, Switzerland, whose blood culture yielded Streptococcus pneumoniae in the period from January 1986 through December 2000. Results. 405 episodes of pneumococcal bacteremia in 394 patients were identified. The mean annual incidence was 1.78 episodes per 1,000 hospital admissions. Most common risk factors were cigarette smoking, chronic lung disease, malignancy, and alcohol misuse. HIV-infection was known in 46 episodes (11%). During the study period, the nonsusceptibility of pneumococci against penicillin increased from 0% to 17%. The overall mortality was 25%. The case-fatality rate decreased from 32% to 17% during the second half of the study period (P < 0.001). Independent risk factors for fatal outcome were coronary heart disease, neutropenia, and increasing age, whereas prior respiratory infection and the occurrence of bacteremia in the second half of the study period were independent predictors of survival. Mortality in HIV-infected patients was lower than in HIV-noninfected subjects (9% versus 27%, P = 0.007). Conclusions. Despite increased numbers of penicillin-nonsusceptible strains, mortality of pneumococcal pneumonia significantly decreased in the second half of study period.

Streptococcus pneumoniae bacteremia in children infected with HIV: presentation, course, and outcome.

To examine the presentation, course, and outcome of pneumococcal bacteremia in children infected with human immunodeficiency virus (HIV). A retrospective series of HIV-infected children less than 18 years of age with Streptococcus pneumoniae bacteremia from four urban, tertiary care hospitals was evaluated. The main outcome measures included persistent bacteremia, the development of a focal infection, and death. Seventy-two episodes of pneumococcal bacteremia were identified in 59 patients. Fifty-four first episodes were included; 26/54 were occult. Mean temperature was 39.8 degrees C. In patients with bacteremia, white blood cells (WBCs) > or = 15,000 and > or = 10,000 had sensitivities of 40% and 75%, respectively. At the time of bacteremia, age >3 years old was associated with a lower mean WBC count compared with episodes occurring in patients <3 years old (11.2 vs 16.1, P < 0.05). Patients with occult bacteremia who were discharged with antibiotics (12 i.m., 7 p.o.) were less likely than patients without antibiotic treatment to have persistent bacteremia at a return visit within 72 hours (0/19 vs 2/5, P < 0.05). No patient with occult bacteremia died, progressed to clinical meningitis, or had other sequelae. Two of fifty-four patients died as a result of their first episode of invasive pneumococcal disease. Both patients who died had meningitis and appeared ill on initial presentation. Neither a WBC count > or = 15,000 nor > or = 10,000 is a sensitive indicator of pneumococcal bacteremia in HIV-infected children. Empiric antibiotics are useful to decrease the risk of persistent bacteremia. Children infected with HIV who have occult pneumococcal bacteremia appear to do well with appropriate antibiotics. Patients who are afebrile and well appearing on reevaluation may be safely treated as outpatients.

The Role of Human Immunodeficiency Virus Infection in Pneumococcal Bacteremia in San Francisco Residents

Human immunodeficiency virus (HIV) is an important risk factor for invasive pneumococcal disease, but information on clinical course and infecting serotypes is limited. To help develop strategies to reduce the morbidity due to invasive pneumococcal disease, episodes of pneumococcal bacteremia were identified by retrospective review of microbiology records (November 1983-November 1987) at 10 San Francisco hospitals and, for patients 20-55 years old living in San Francisco, HIV antibody status was determined by review of medical records. Pneumococcal isolates from one hospital were serotyped. Of 294 patients with pneumococcal bacteremia identified, 32 (11%) had AIDS at the time pneumococcal bacteremia was diagnosed and another 43 (15%) were HIV-infected but did not have AIDS; 12 HIV-infected patients developed AIDS after the episode of pneumococcal bacteremia. The rate of pneumococcal bacteremia in AIDS patients was estimated to be 9.4/1000 patient-years. Serotypes of 27 (82%) of 33 pneumococcal isolates from HIV-infected patients and 107 (90%) from 119 patients without known HIV infection were among the 23 serotypes included in the currently available polysaccharide vaccine. The rate of pneumococcal bacteremia is approximately 100-fold greater in AIDS patients in San Francisco than rates reported before the AIDS epidemic, but more than half the episodes of pneumococcal bacteremia in HIV-infected patients occurred in patients without AIDS. Data on pneumococcal serotypes causing invasive disease in HIV-infected patients suggest that the current pneumococcal vaccine, if effective in this population, could provide significant protection against pneumococcal disease.

Pneumococcal bacteremia. Update from an adult hospital with a high rate of nosocomial cases.

Eighty-nine episodes of pneumococcal bacteremia were reviewed over a 66-month period at a Veterans Administration Medical Center. Forty-one percent of these episodes were nosocomial in origin, and 59% of the patients were elderly (60 years of age or older). Nosocomial infection occurred more often in the elderly (55%) compared to those less than 60 years of age (32%; P less than 0.05). Within the elderly group, those older than 75 years of age had a higher rate of nosocomial bacteremia than those 60 to 75 years of age (76 versus 44%; P less than 0.05). The clinical presentation of the elderly and younger groups was not significantly different. All but one patient had serious underlying diseases. Eighty-three percent of the episodes were due to pneumonia, and penicillin alone was prescribed for only 21% of all cases. The mortality rate directly due to the bacteremia was 22%, while the overall mortality during the hospitalization was 47%. In the elderly, the percentage of deaths due to infection was similar to the younger group, but overall mortality during the hospitalization was significantly higher in the elderly (74 versus 26%; P less than 0.01). Physicians showed poor recognition of the significance of pneumococcal disease, as demonstrated by inclusion of the diagnosis of pneumococcal infection or bacteremia in only 27% of the discharge summaries and by predischarge vaccination of only 7% (6 of 82) of those without previous pneumococcal vaccination. In conclusion, the rate of nosocomial pneumococcal bacteremia was high in a predominantly elderly male population; it may be appropriate to consider a hospital-based vaccine program in similar populations.