INVASIVE PNEUMOCOCCAL DISEASE - CLINICAL-FEATURES, SEROTYPES, AND ANTIMICROBIAL RESISTANCE PATTERNS IN CASES INVOLVING PATIENTS WITH AND WITHOUT HUMAN-IMMUNODEFICIENCY-VIRUS INFECTION

We reviewed 153 episodes of invasive pneumococcal disease involving 14 7 hospitalized patients with and without human immunodeficiency virus (HIV) disease to examine and compare epidemiologic and clinical featur es, capsular serotypes, and antibiotic susceptibility patterns. HIV in fection was the most common risk factor for invasive pneumococcal dise ase. Pneumococcal disease in HIV-infected individuals was characterize d by the greater frequency with which pneumonia was the source of bact eremia (90% vs. 63%) (P < .01) and an increased recurrence rate (15% v s. < 1%) (P < .01). The overall mortality rate was 12% and did not var y by HIV serostatus. Capsular-type data were available for 149 episode s; 90% of the types were among those found in the polyvalent pneumococ cal vaccine. The four most common capsular types causing invasive dise ase were 14, 6b, 9v, and 22f; capsular type 9v was significantly more common among HIV-infected patients (P < .01). penicillin-resistant iso lates were identified in 7.2% of all cases, and their presence did not vary by HIV status; 20% of isolates from cerebrospinal fluid were res istant. The majority of the resistant isolates were of capsular type 9 v. Given the worldwide increase in both HIV and penicillin-resistant p neumococcal infections, better preventative and therapeutic strategies are greatly needed.