Pneumococcal infections in intensive care units: 8-year retrospective

OBJECTIVE: The aim of this study was to analyze the clinical presentations and severity of S. pneumoniae infections requiring hospitalization in an in tensive care unit and evaluate the incidence and severity of infections cau sed by penicillin-resistant strains. PATIENTS AND METHODS: This retrospective study reviewed cases in our intens ive care unit from January 1989 through December 1996 including all patient s with pneumococcal infection. RESULTS: The study included 102 patients, mean age 59.6 years. Pneumonia wa s the most frequent (83 cases) followed by bacteriemia (31 cases) and menin gitis (15 cases). Mortality was high (43%) and influenced by age, simplifie d severity score, and presence of shock at admission. Antibiotic resistance appeared in 1991 and increased over the years reaching, in 1996. 24% for p enicillin, 38% for macrolides, 20% for sulfamides, 19% for tetracyclins, an d 14% for phenicols. Penicillin-resistance was not found to modify clinical expression nor severity of infection. Amoxicillin and third-generation cep halosporins were the most widely used antibiotics. CONCLUSION: Pneumococcal infections in intensive care patients are severe w ith high mortality. The emergence of more and more resistant strains has li ttle clinical consequence on severity or treatment.