PREVALENCE OF HUMAN-IMMUNODEFICIENCY-VIRUS INFECTION, MORTALITY-RATE,AND SEROGROUP DISTRIBUTION AMONG PATIENTS WITH PNEUMOCOCCAL BACTEREMIA AT DENVER GENERAL-HOSPITAL, 1984-1994

Pandemics of human immunodeficiency virus (HIV) type 1 infection and p enicillin resistance highlight the urgency of preventing invasive pneu mococcal disease with vaccination. We characterized pneumococcal serog roup distribution and the mortality rate among 460 patients with pneum ococcal bacteremia from 1984 through 1994 at Denver General Hospital a nd the prevalence of HIV infection in patients for whom pneumococcal b acteremia was diagnosed from 1989 to 1994. Vaccine-related serogroups accounted for 426 isolates (92.6%), including 48 (92.3%) of 52 isolate s from HIV-infected patients. Mortality among patients 15 years of age or older was higher during 1984-1988 (18[12.9%] of 140) than during 1 989-1994 (10[5.2%] of 191: rate ratio, 2.5; 95% confidence interval, 1 .2-5.2). Of patients 15-59 years of age from 1989 to 1994, 44 (39.6%) of 111 men and three (7.3%) of 41 women were HIV-infected. Four (8.5%) of 47 HIV-infected patients and four (3.8%) of 105 other patients in this group died (age-weighted rate ratio, 1.8; 95% confidence interval , 0.5-6.2). We recommend routine screening of young adults with pneumo coccal bacteremia for HIV infection and immunization of HIV-infected p atients with pneumococcal vaccine (which includes most serogroups of i nfecting strains).