Systemic pneumococcal infections at Aker University Hospital 1998-2003 - clinical and laboratory aspects

Abstract

Background: Streptococcus pneumoniae is an important pathogenic organism all over the world and in all age groups. S. pneumoniae is a frequent cause of pneumonia, menigitis, sinusitis, and otitis media and a less frequent cause of endocarditis, septic athritis, and peritonitis. In spite of the availability of highly effective antiobiotics and modern intensive care facilities, mortality in systemic pneumococcal infections remains high worldwide.

Materials and methods: The case records of 162 patients with systemic pneumococcal infections occuring at Aker University Hospital in the period 1998-2003 were retrospectively analyzed. Systemic pneumococcal infection was verified by cultures from blood, cerebrospinal fluid, or synovial fluid. The patients were analyzed by sex, age, focus of infection, predisposing factors, clinical presentation, laboratory data, chest X-ray findings, treatment, and ultimate outcome.

Results: Systemic pneumoccal infection occurred most frequently in the older age groups and 81,5 % of the patients had at least one predisposing factor. The most common focus of infection was the lungs. Atypical presentation was common with gastrointestinal symptoms occuring in 35,1 % of the cases. 75,3 % of the patients should have been offered pneumococcal vaccination according to the Norwegian recommendations. The total case fatality rate was 21,6 %. The mortality was significantly higher among men, patients with at least one predisposing factor, patients with cardiovascular disease, patients without fever, and patients with impared level of consciousness. The patients who died had also significantly lower leucocyte counts and higher levels of serum creatinine.

Conclusion: The high mortality of systemic pneumococcal infections underscores the importance of following the present recommendations on the use of pneumococcal vaccine in high-risk patients.