Adult bacteremic pneumococcal pneumonia in a community teaching hospital, 1992-1996 - A detailed analysis of 108 cases
acquired pneumonia; antimicrobial resistance; diagnosis; disease; General & Internal Medicine; penicillin-resistant pneumococci; polysaccharide vaccine; risk-factors; sputum culture; Streptococcus pneumoniae; united-states
Objectives: To review the clinical and laboratory findings of 108 adult patients with bacteremic pneumococcal pneumonia admitted to a community hospital and to determine the value of sputum Gram stains and cultures in the diagnosis of pneumococcal pneumonia in this setting. Methods: Using the laboratory logbooks to identify adult inpatients with pneumococcal bacteremia from January 1, 1992, to June 30, 1996, we reviewed medical records. Results: We found 108 patients. There was an apparent increase in prevalence from 1995 to 1996 compared with 1992 to 1994. Patients included 44 men and 64 women. Ages ranged from 20 to 95 years (median, 70 years). The fatality rate was 24.1% and increased with advancing age (no patient younger than 45 years died, and 36.8% of patients aged 85-95 years died). Cigarette smoking, cardiovascular disease, chronic obstructive lung disease, malignant disease, and diabetes mellitus were major underlying conditions. Fever, dyspnea, and cough were the most common presenting symptoms. Sputum Gram stain was useful in the diagnosis when moderate to abundant Gram-positive diplococci were seen. Sputum culture was less useful. Factors associated with higher fatality rate were being 65 years of age or older, APACHE II (Acute Physiologic and Chronic Health Evaluation II) score greater than 15, intensive care unit admission, low or normal leukocyte count, thrombocytopenia, renal dysfunction, diffused infiltrates on chest radiography, bilateral pneumonia, and sputum culture positive for Streptococcus pneumoniae. Conclusions: We found a recent increase in the prevalence of bacteremic pneumococcal pneumonia in adults. Gram stain of sputum is useful, but sputum culture is less sensitive in the diagnosis of pneumococcal pneumonia. The fatality rate remains high. More effort should be made at prevention using pneumococcal immunization.
Watanakunakorn C; Bailey T A
Archives of Internal Medicine
1997
1997-09
Journal Article
<a href="http://doi.org/10.1001/archinte.157.17.1965" target="_blank" rel="noreferrer noopener">10.1001/archinte.157.17.1965</a>
Distribution of 13-Valent Pneumococcal Conjugate Vaccine Streptococcus pneumoniae Serotypes in US Adults Aged >= 50 Years With Community-Acquired Pneumonia
13-valent pneumococcal; care-associated pneumonia; cohort; community-acquired pneumonia; conjugate vaccine; disease; efficacy; epidemiology; healthcare-associated pneumonia; immunization; Immunology; Infectious Diseases; Microbiology; older-adults; pneumococcal serotypes; polysaccharide vaccine; population; serotype distribution; Streptococcus pneumoniae; united-states; urinary antigen detection assay
Background. Streptococcus pneumoniae causes a substantial proportion of community-acquired pneumonia (CAP) and healthcare-associated pneumonia (HCAP) in the United States. Limited data are available regarding the pneumococcal serotypes causing CAP and HCAP. Methods. Adults aged >= 50 years presenting to participating US hospitals with radiographically confirmed pneumonia between February 2010 and September 2011 were screened for inclusion. S. pneumoniae was identified using microbiological cultures, BinaxNOW (R) S. pneumoniae assay, or urine antigen detection (UAD) assay capable of detecting 13-valent pneumococcal conjugate vaccine (PCV13)-associated serotypes. Results. Among 710 subjects enrolled, the median age was 65.4 years; 54.2% of subjects were male, 22.4% of radiographically confirmed pneumonia cases were considered HCAP, and 96.6% of subjects were hospitalized. S. pneumoniae was detected in 98 subjects (13.8%) by any test, and PCV13-associated serotype(s) were identified by UAD in 78 (11.0%). Serotype 19A was most prevalent, followed by 7F/A, 3, and 5. Serotypes associated with 7-valent pneumococcal conjugate vaccine (PCV7) accounted for 25% of UAD-positive isolates. Conclusions. Pneumococcal serotypes causing noninvasive pneumonia in adults may differ significantly from those causing invasive disease, with PCV7-associated serotypes overrepresented. Serotype 5, rarely seen in contemporary surveillance of invasive disease in the United States, substantially contributed to the observed cases of S. pneumoniae-positive CAP or HCAP.
Sherwin R L; Gray S; Alexander R; McGovern P C; Graepel J; Pride M W; Purdy J; Paradiso P; File T M
Journal of Infectious Diseases
2013
2013-12
Journal Article
<a href="http://doi.org/10.1093/infdis/jit506" target="_blank" rel="noreferrer noopener">10.1093/infdis/jit506</a>