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Pneumococcal bacteremia in adults: a 14-year experience in an inner-city university hospital
B Afessa1, W L Greaves, W R Frederick
1Department of Medicine, Howard University Hospital, Washington, DC 20060, USA.
Abstract:
We retrospectively reviewed 304 episodes of pneumococcal bacteremia in 293 adults to compare the clinical features, prognostic factors, and case-fatality rate associated with this illness to those in previous studies. We studied patients at an inner-city university hospital who had pneumococcal bacteremia from January 1980 through December 1993. We analyzed patient demographics, risk factors for pneumococcal infection, pneumococcal vaccination status, initial vital signs, findings on chest roentgenograms, arterial blood gases, and laboratory values. Ninety-six percent of our study population was African American and 61% were male; pneumococcal vaccination was documented for 2%. The case-fatality rate in our study was 36%. Older age, lower mean arterial pressure, lower mean temperature, higher respiratory rate, multilobar pneumonia, leukopenia, low platelet count, hypoalbuminemia, low arterial pH, low arterial oxygen tension, and high arterial carbon dioxide tension were associated with higher mortality. Our study suggests that mortality due to pneumococcal bacteremia has not changed significantly in the last 6 decades, that the number of patients in high-risk groups who are receiving pneumococcal vaccine is insufficient, and that higher mortality can be predicted from the history, vital signs, and laboratory values at initial presentation.
Insights
Mortality from pneumococcal bacteremia remains high, with a 36% case-fatality rate observed in this study. Key prognostic factors at initial presentation predict higher mortality, underscoring the need for improved pneumococcal vaccination in high-risk adults.
Area of Science:
- Infectious Diseases
- Internal Medicine
- Critical Care Medicine
Background:
- Pneumococcal bacteremia is a serious infection with significant mortality.
- Previous studies on pneumococcal bacteremia have varied in their findings regarding mortality and prognostic factors.
- Understanding current clinical features and outcomes is crucial for effective management.
Purpose of the Study:
- To compare clinical features, prognostic factors, and case-fatality rates of pneumococcal bacteremia in adults.
- To identify predictors of mortality in patients with pneumococcal bacteremia.
- To assess the impact of pneumococcal vaccination in a contemporary patient cohort.
Main Methods:
- Retrospective review of 304 episodes of pneumococcal bacteremia in 293 adult patients.
- Analysis of patient demographics, risk factors, vaccination status, vital signs, chest roentgenograms, arterial blood gases, and laboratory values.
- Comparison of findings with previous studies spanning several decades.
Main Results:
- The case-fatality rate was 36%, with no significant change over six decades.
- High-risk groups showed insufficient pneumococcal vaccination rates (2%).
- Older age, lower mean arterial pressure, hypothermia, tachypnea, multilobar pneumonia, leukopenia, thrombocytopenia, hypoalbuminemia, and abnormal arterial blood gases predicted higher mortality.
Conclusions:
- Mortality due to pneumococcal bacteremia has remained largely unchanged over the past 60 years.
- Current pneumococcal vaccination rates in high-risk populations are insufficient.
- Initial patient presentation, including history, vital signs, and laboratory values, can predict mortality.