INVASIVE STREPTOCOCCUS-PNEUMONIAE INFECTION ASSOCIATED WITH RAPIDLY FATAL OUTCOME IN TAIWAN

We observed 42 cases of invasive Streptococcus pneumoniae infections f rom 1991 through 1993 in southern Taiwan, The antimicrobial susceptibi lities and distribution of serotypes of the 42 isolates from these inv asive infections were determined. Serotypes 14, 3, 6, 23, 15 and 4 wer e most commonly identified. Serotypes 14 and 6 most frequently caused infections in pediatric patients, while serotypes 3, 14 and 23 were co mmonly encountered in adults. Overall, 85.7% of the isolates were incl uded in the serotypes represented in tile 23-valent pneumo-coccal vacc ine, Three isolates a cre intermediately resistant to penicillin and n one were fully resistant. Resistance rates were: erythromycin, 61.9%; clindamycin, 47.6%; chloramphenicol, 19%; and tetracycline, 73.8%. Res istance to three or more classes of antibiotics was round in 33.3% of the isolates, in which the majority were serotypes 14 and 6 and nontyp eable isolates. Bacteremic pneumonia and primary bacteremia accounted for 64.3% of the infections. Mortality was 42.6%. Factors associated w ith higher mortality included age of > 16 years, the presence of under lying diseases, development of one or more septic complications, bacte remic pneumonia and the presence of serotype 3 isolates. Rapidly fatal outcome (the illness developed less than 48 hours prior to admission and the death occurred within 48 hours of hospitalization) occured in 12 (66.7%) of the 18 patients who died. All these patients received ad equate antibiotic treatment and aggressive intensive care, indicating the fulminant nature of this infection. Mucoid serotype 3 isolates cau sed rapidly fatal outcomes. Given the severity of these infections des pite adequate antibiotic therapy and the vulnerability of patients wit h altered immune responses, there is a dire need for introduction of n ew therapeutic options and preventive measures to prevent mortality du e to invasive S. pneumoniae infections.