Pneumococcal bacteremia at a medical/surgical hospital for adults between 1975 and 1980

All 72 episodes of pneumococcal bacteremia from 1975 through 1980 at Montefiore Hospital, Pittsburgh, a medical/surgical hospital for adults, were reviewed. There were 10 to 14 episodes per year, accounting for 4 to 5 percent of all bacteremias; it was estimated that one episode occurred for every thousand patients discharged. Patients' ages ranged from 16 to 94 years (mean 61 years); 65 percent were male. There was an underlying disease in 87 percent of all patients, and 78 percent of the infections were community-acquired. Treatment with antimicrobial drugs was given to all but six patients. Overall mortality was 43 percent, but it was higher for asplenic patients (five of six died). In 44 percent of patients, one to four complications occurred. Outcome correlated with presence of coexisting disease (p less than 0.03), development of one or more complications (p less than 0.04), presence of asplenia (p = 0.04), and the type of antimicrobial treatment used (p less than 0.001; patients treated with penicillin alone fared better). Typing of isolates in the last two study years revealed that 67 percent of isolates were pneumococcal types present in 14-valent pneumococcal vaccine available at the time of the study. It is concluded that pneumococcal bacteremia occurs primarily in patients with underlying disease, and that pneumococcal vaccine should be offered to such patients.