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Pneumococcal bacteraemia in adults in a low socio-economic urban population
Abstract:
Between January 1984 and December 1985, 183 adult patients, subsequently shown to have pneumococcal bacteraemia, were admitted. Of these infections, nine were caused by penicillin-resistant strains, and three of these were resistant to other antibiotics. The organisms from 150 patients were serotyped/grouped. The primary site of infection was lung in 90 per cent of patients. Among the patients with pneumonia, those with serovar 3 strains accounted for most intensive care unit admissions, most cases requiring inotropic drugs, and mechanical ventilation and had the highest complication rate and mortality. Findings which predicted the need for intensive care included higher age, elevated concentrations of serum urea, creatinine, and phosphate and lower levels of total serum protein, albumin and calcium. Twenty-four patients died of whom 23 had pneumonia. The case fatality rate among all of the patients admitted to the intensive care unit was 60 per cent and among those not admitted to the unit, 9.2 per cent. Of the patients who died, 41.7 per cent did so within the first five days of admission. The prophylactic use of polyvalent pneumococcal vaccine in industrial workers from low socio-economic groups should be carefully considered.
Insights
Pneumococcal bacteraemia, particularly from serovar 3, led to high intensive care unit admissions and mortality. Vaccine consideration is advised for at-risk industrial workers.
Area of Science:
- Infectious Diseases
- Clinical Microbiology
- Epidemiology
Background:
- Pneumococcal bacteraemia is a significant cause of severe illness and death.
- Penicillin-resistant strains pose a growing challenge in treating pneumococcal infections.
- Understanding risk factors and predictors of severe outcomes is crucial for patient management.
Purpose of the Study:
- To investigate the clinical characteristics and outcomes of adult patients with pneumococcal bacteraemia.
- To identify specific pneumococcal serovars associated with severe disease and mortality.
- To determine predictors of intensive care unit (ICU) admission and death in pneumococcal bacteraemia.
Main Methods:
- Retrospective analysis of 183 adult patients admitted with pneumococcal bacteraemia between January 1984 and December 1985.
- Serotyping/grouping of bacterial isolates from 150 patients.
- Comparison of clinical data, including demographics, primary infection site, ICU admission, treatment, complications, and mortality.
Main Results:
- The lung was the primary site of infection in 90% of patients.
- Serovar 3 strains were associated with the highest rates of ICU admission, mechanical ventilation, and mortality.
- Predictors for ICU admission included advanced age, elevated serum urea, creatinine, phosphate, and low total serum protein, albumin, and calcium.
- The overall case fatality rate was 12.9%, with 60% mortality in the ICU group versus 9.2% in the non-ICU group.
Conclusions:
- Pneumococcal pneumonia, especially serovar 3, is associated with high morbidity and mortality.
- Prompt identification of clinical indicators for ICU admission is vital for timely intervention.
- Prophylactic polyvalent pneumococcal vaccination should be considered for high-risk populations, such as industrial workers from low socio-economic groups.