Bacteremia-associated pneumococcal pneumonia and the benefit of initial parenteral antimicrobial therapy

Objectives. To describe clinical characteristics of patients with bacteremi a-associated pneumococcal pneumonia (BAPP) and evaluate features that may d istinguish these patients from those with uncomplicated pneumococcal bacter emia. To determine the impact of the route of initial antibiotic therapy on the clinical course of patients with BAPP, Design/methods. Retrospective review of children with pneumococcal bacterem ia comparing those with pneumonia to those without focal infections. Results. We identified 110 patients with BAPP and 112 patients with pneumoc occal bacteremia alone. Patients with pneumonia were significantly older (m ean age, 34 vs. 19 months; P = 0.002) and more likely to present with cough /congestion (28% vs. 14%; P = 0.01) or difficulty breathing (12% vs. 4%; P = 0.047), There was no difference in mean temperature (39.5 vs. 39.7 degree s C; P = 0.3), mean white blood cell count WBC (21.9 vs. 22.6 x 1000/mm,(3) P = 0.5) or presence of tachypnea (23% vs. 22%, P = 0.8). Sixty-one patien ts (55%) with pneumonia were discharged home from the initial visit in the emergency department. Those who received a parenteral antibiotic before dis charge, when compared with the group who received an oral antibiotic alone, were more likely to have an improved condition (95% vs, 67%, P = 0.03) and were less likely to be admitted to the hospital (0% vs. 24%; P = 0.007) at follow-up. Conclusions. Children with bacteremia-associated pneumococcal pneumonia are older and more:likely to complain of cough/congestion or difficulty breath ing than those with uncomplicated pneumococcal bacteremia. The use of a par enteral antibiotic at the initial visit for children with bacteremia-associ ated pneumococcal pneumonia resulted in a lower admission rate and more lik ely parental report of improved condition at follow-up than those for child ren treated only with an oral antibiotic.