Prognostic factors for pneumococcal bacteremia in a university hospital

The records of adult patients with pneumococcal bacteremia who were seen ov er an 8-year-period at an 1100-bed university teaching hospital were review ed in order to revise the clinical and laboratory findings and to identify the risk factors associated with mortality. A total of 156 patients were st udied, 101 men and 55 women. The mean age of the patients was 65 years. Eig hty-seven percent of the patients had community-acquired bacteremia and 13% had nosocomial pneumococcal bacteremia. The overall mortality was 33.9% an d the related mortality was 20.5%. The following factors were associated wi th an increased risk of adverse outcome in the univariate analysis: mechani cal ventilation (risk ratio [RR] = 3.40; 95% confidence interval [95% CI] = 1.44-8.05), administration of parenteral nutrition (RR = 3.40; 95% CI = 1. 44-8.05), and the presence of an intravenous catheter (RR = 2.33; 95% CI = 1.27-4.24). In the multivariate analysis, the independent prognostic factor s for mortality were as follows: development of clinical complications duri ng the episode of bacteremia, rapidly fatal illness, advanced age and admin istration of parenteral nutrition. The results suggest that the overall mor tality due to pneumococcal bacteremia continues to be high. Four independen t risk factors associated with increased mortality were identified. Prevent ion and immunization with polyvalent pneumococcal polysaccharide vaccine sh ould be practiced more widely.