PNEUMOCOCCAL BACTEREMIA IN ADULTS - A 14-YEAR EXPERIENCE IN AN INNER-CITY UNIVERSITY HOSPITAL

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 s tudies. We studied patients at an inner-city university hospital who h ad pneumococcal bacteremia from January 1980 through December 1993. We analyzed patient demographics, risk factors for pneumococcal infectio n, pneumococcal vaccination status, initial vital signs, findings on c hest roentgenograms, arterial blood gases, and laboratory values. Nine ty-six percent of our study population was African American and 61% we re male; pneumococcal vaccination was documented for 2%. The case-fata lity rate in our study was 36%. Older age, lower mean arterial pressur e, lower mean temperature, higher respiratory rate, multilobar pneumon ia, 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 mortali ty due to pneumococcal bacteremia has not changed significantly in the last 6 decades, that the number of patients in high-risk groups who a re receiving pneumococcal vaccine is insufficient, and that higher mor tality can be predicted from the history, vital signs, and laboratory values at initial presentation.