Pneumococcal bacteremia in adults in Soweto, South Africa, during the course of a decade

We retrospectively reviewed 414 episodes of pneumococcal bacteremia that oc curred in adults from July 1986 through June 1987 (1986/1987) and from July 1996 through June 1997 (1996/1997) to monitor the incidence and clinical a nd laboratory characteristics and to assess the influence of human immunode ficiency virus (HIV) infection on any changes. The incidence increased from 26 per 100,000 persons in 1986/1987 to 36 per 100,000 persons in 1996/1997 ; the increase was most marked among patients who were aged 25-44 years (24 cases per 100,000 persons to 45 per cases 100,000 persons) and greater tha n or equal to 65 years (43 cases per 100,000 persons to 50 cases per 100,00 0 persons). Of 161 patients who were tested for HIV in 1996/1997, 108 (67%) were HIV seropositive. Among the general population, the prevalence of oth er underlying diseases and smoking decreased from 45% and 67%, respectively , in 1986/1987 to 23% (P<.0001) and 35% (P<.0001) in 1996/1997. Strains of pneumococci that were not susceptible to penicillin were found in 4% patien ts in 1986/1987 and 12% in 1996/1997 (P=.005). This increase occurred exclu sively among the HIV-infected patients (22% of the HIV-sero- positive patie nts versus 4% of HIV-seronegative patients; P = .008), and there was a para llel increase for childhood serotypes (51% of HIV-seropositive patients ver sus 17% of HIV-seronegative patients; P<.0001).