PNEUMOCOCCAL COMMUNITY-ACQUIRED PNEUMONIA IN 148 HOSPITALIZED ADULT PATIENTS

In a previous prospective study, Streptococcus pneumoniae was identifi ed as the causative agent in 148 (42.8%) of 346 adult patients hospita lized over the course of one year with community-acquired pneumonia (C AP) in the Soroka Medical Center, Beer-Sheva, Israel, The present stud y characterizes those cases in which Steptococcus pneumoniae was the o nly pathogen and those in which additional etiological agents were ide ntified, Pneumococcal CAP was diagnosed by standard blood cultures or positive serological tests by one of two laboratory methods, In 100 (6 7.6%) patients, at least one other etiological agent of CAP was identi fied in addition to Streptococcus pneumoniae, Compared with patients w ho were not infected by Streptococcus pneumoniae, patients with Strept ococcus pneumoniae CAP were older and had a higher rate of comorbidity (39.5% vs. 29.8%), Streptococcus pneumoniae CAP had a more severe cli nical course and a higher mortality rate, especially when Streptococcu s pneumoniae was the only pathogen, Community-acquired pneumonia due t o Streptococcus pneumoniae only was more similar in its clinical manif estations to classic typical pneumococcal pneumonia, When an additiona l etiological agent was identified, the clinical characteristics could not be distinguished from those of atypical pneumonia, It is conclude d that Streptococcus pneumoniae remains the principal cause of CAP in this region, The frequency of additional etiological agents of CAP and the difficulty in differentiating clinically between cases due to Str eptococcus pneumoniae only and those due to Streptococcus pneumoniae p lus other organisms necessitates initial empirical treatment that cove rs Streptococcus pneumoniae as well as other causative agents of a typ ical pneumonia.