Prognostic factors for pneumococcal bacteremia in a university hospital

The records of adult patients with pneumococcal bacteremia who were seen over an 8-year-period at an 1100-bed university teaching hospital were reviewed in order to revise the clinical and laboratory findings and to identify the risk factors associated with mortality. A total of 156 patients were studied, 101 men and 55 women. The mean age of the patients was 65 years. Eighty-seven percent of the patients had community-acquired bacteremia and 13% had nosocomial pneumococcal bacteremia. The overall mortality was 33.9% and the related mortality was 20.5%. The following factors were associated with an increased risk of adverse outcome in the univariate analysis: mechanical ventilation (risk ratio [RR] = 3.40; 95% confidence interval [95% CI] = 1.44-8.05), administration of parenteral nutrition (RR = 3.40; 95% CI = 1.44-8.05), and the presence of an intravenous catheter (RR = 2.33; 95% CI = 1.27-4.24). In the multivariate analysis, the independent prognostic factors for mortality were as follows: development of clinical complications during the episode of bacteremia, rapidly fatal illness, advanced age and administration of parenteral nutrition. The results suggest that the overall mortality due to pneumococcal bacteremia continues to be high. Four independent risk factors associated with increased mortality were identified. Prevention and immunization with polyvalent pneumococcal polysaccharide vaccine should be practiced more widely.