Comparison of community-acquired and nosocomial pneumococcal bacteremia

We evaluated pneumococcal bacteremia retrospectively for 3.5 yr. Sixty-three episodes occurred in 62 patients; 37 were nosocomial in origin; 26 were community-acquired. Pneumococcal bacteremia was most common between January and June. Patients with nosocomial disease had significantly more ultimately fatal disease and sustained more manipulation of the respiratory tract than patients with community-acquired bacteremia. The mortality of nosocomial pneumococcal bacteremia (75.8%) or nosocomial pneumococcal pneumonia with bacteremia (66.7%) was significantly greater than community-acquired bacteremia (26.9%; p less than 0.01) or pneumonia with bacteremia (18.2%; p less than 0.001). All 62 patients were eligible for pneumococcal vaccine, and 57 could have received immunoprophylaxis. A vaccine trial is indicated in the hospital setting.