Journal Review
November 1, 1999 2 minutes read
Journal Review
Rubins JB, Cheung S, Carson P, et al. Identifi cation of clinical risk factors for nosocomial pneumococcal bacteremia. Clin Infect Dis 1999; 29:178-183.
Streptococcus pneumoniae, the leading cause of community-acquired bacteremic pneumonia in the United States, also has been identified as a cause of nosocomial bacteremia, particularly in the elderly, the chronically ill, and veterans, the authors report. Nosocomial pneumococcal bacteremia (NPB) is a highly lethal infection associated with distinct but identifiable clinical risks, symptoms, and signs. NPB is associated with an appreciably higher mortality than is community-acquired infection, even when appropriate antibiotics and supportive therapy are promptly instituted, they note. Further more, hospital-acquired pneumococcal infection may be associated with emergence of antibiotic-resistant strains, they note.
The authors performed a case-control study of NPB, pairing each of 37 cases identified retrospectively at a medical center from the period of 1984-1994 with four or five hospitalized controls. Comorbidities identified at the time of admission that were significantly associated with NPB on univariate and multivariate analysis included respiratory or hematologic malignancy, anemia, chronic obstructive pulmonary disease, and coronary artery disease. All characteristic symptoms and signs of pneumococcal infection were significantly more common in cases than in controls. NPB was strongly associated with death within seven days of the index blood culture date, and the mortality rate among cases was 40.5%, compared with 1.2% among nonbacteremic controls.
The respiratory symptoms of cough and sputum, noted in more than half of the patients with community-acquired pneumococcal bacteremia, were significantly less common among cases of NPB. Conversely, substantially greater proportions of patients with NPB had extrapulmonary symptoms, such as gastrointestinal complaints and nonspecific changes in mental status.
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