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