Clinical characteristics and outcome of patients with invasive pneumococcal disease, Puy-de-Dome, France, 1994-1998

A surveillance program for invasive pneumococcal disease was undertaken in Puy-de-Dome, an administrative district of the region Auvergne in France, f rom 1 January 1994 to 31 December 1998. A total of 214 cases were identifie d. The annual incidence of invasive pneumococcal disease increased (P=0.04) from 5.5 in 1994 to 9.3 cases per 10(5) person-years in 1998. The highest incidences were for children <2 years of age (59.2 cases per 10(5) person-y ears) and for adults greater than or equal to 65 years (18 cases per 10(5) person-years). Clinical diagnoses, available in 200 patients, included acut e pneumonia (62%), meningitis (10%), sepsis without focus (20%), and others (8%). The most frequent chronic medical conditions of the patients include d smoking, alcoholism, cardiovascular and pulmonary diseases, and malignanc ies. Thirty-one percent of the isolates were nonsusceptible to penicillin. Penicillin resistance (MIC greater than or equal to0.1 mg/l) was more frequ ent (P=0.02) in cancer patients. The overall case-fatality rate was 21.5%. Risk factors for death were age, sex, and underlying diseases of the patien ts, along with the severity of illness. These population-based findings sho uld convince clinicians to offer pneumococcal vaccine to patients at high r isk for invasive pneumococcal disease, thereby increasing vaccination cover age levels in France.