[Epidemiologic characteristics of pneumococcal bacteremia in the era of AIDS]

The HIV infection and the development of penicillin-resistant pneumococci justify the review of the epidemiologic features of pneumococcal pneumonia in the last years.

A retrospective chart review of all patients admitted between 1987 and 1990 with a positive blood culture to Streptococcus pneumoniae was conducted. Different epidemiologic variables were selected ad compared.

Streptococcus pneumoniae was isolated in 147 blood cultures from 147 patients. The estimated incidence of pneumococcal bacteremia was 10 cases per 100,000 inhabitants/year. The figure increases from 7 to 12 cases during the study period. The risk factors identified were: HIV infection, 27 patients (19%); cancer, 14 patients (10%); cirrhosis of the liver, 13 patients (9%). In 56 cases (38%) no special risk factors were identified. All bacteremic episodes were from a pulmonary source. In 66% of patients, no special complications were recorded. Mortality outcome was related to age (28% if aged more than 60 years, 7% if less; p = 0.001, chi 2, and with the underlying condition (p = 0.034, chi 2). Resistance to penicillin increases from 0.0% to 21% during the study period (p = 0.03, chi 2) but it seems not to have any impact in mortality nor in the nosocomial origin of the bacteremia.

In the last 4 years we have observed an increase in the incidence of pneumococcal bacteremia related to an increase in cases among HIV infected patients, and also the emergence of penicillin-resistant strains. However, none of the two mentioned conditions seems to have any impact on mortality.