Pneumococcal Bacteremia in Three Community Teaching Hospitals From 1980 to 1989

To review the clinical and laboratory findings in a large number of patients with pneumococcal bacteremia in the 1980s and identify risk factors associated with increased mortality. Retrospective review of medical records identified by blood culture logbooks and ICD-9 codes. Three community teaching hospitals affiliated with a medical school in northeastern Ohio. 385 inpatients with pneumococcal bacteremia admitted between Jan 1, 1980 and Dec 31, 1989. Important clinical and laboratory information was abstracted from patients' medical records, compiled, computerized, and analyzed. The patients' mean age was 48 years. The overall mortality was 25 percent. The mortality increased with age, reaching 42 percent in patients over 65 years old. For these elderly patients, the mortality was higher (55 percent) for patients admitted from nursing homes than patients from the community (36 percent). Higher mortality was also associated with congestive heart failure (p = 0.001), alcoholism/cirrhosis (p = 0.02), diabetes mellitus (p = 0.05), and malignancy (p = 0.02). A platelet count less than 150,000/mm3, renal dysfunction (serum creatinine >2 mg/dl), and the number of lobes involved were also associated with mortality. Patients receiving standard therapy (penicillin, ampicillin, erythromycin, or cephalosporins) had lower mortality. Of the previously specified risk factors for mortality, only age, whether standard therapy was administered, the number of lobes involved, and the serum creatinine level proved to be independent risk factors according to logistic regression. The overall mortality from pneumococcal bacteremia has not decreased during the past 40 years. Risk factors associated with increased mortality were identified. Prevention by immunization with polyvalent pneumococcal polysaccharide vaccine should be practiced more widely.