title: Bacteremia-associated pneumococcal pneumonia and the benefit of initial parenteral antimicrobial therapy.
abstract: OBJECTIVE
  To describe clinical characteristics of patients with bacteremia-associated pneumococcal pneumonia (BAPP) and evaluate features that may distinguish these patients from those with uncomplicated pneumococcal bacteremia. To determine the impact of the route of initial antibiotic therapy on the clinical course of patients with BAPP.
  
  
  METHODS
  Retrospective review of children with pneumococcal bacteremia comparing those with pneumonia to those without focal infections.
  
  
  RESULTS
  We identified 110 patients with BAPP and 112 patients with pneumococcal bacteremia alone. Patients with pneumonia were significantly older (mean age, 34 vs. 19 months; P = 0.002) and more likely to present with cough/congestion (28% vs. 14%; P = 0.01) or difficulty breathing (12% vs. 4%; P = 0.047). There was no difference in mean temperature (39.5 vs. 39.7 degrees C; P = 0.3), mean white blood cell count WBC (21.9 vs. 22.6 x 1000/mm,3 P = 0.5) or presence of tachypnea (23% vs. 22%, P = 0.8). Sixty-one patients (55%) with pneumonia were discharged home from the initial visit in the emergency department. Those who received a parenteral antibiotic before discharge, when compared with the group who received an oral antibiotic alone, were more likely to have an improved condition (95% vs. 67%, P = 0.03) and were less likely to be admitted to the hospital (0% vs. 24%; P = 0.007) at follow-up.
  
  
  CONCLUSIONS
  Children with bacteremia-associated pneumococcal pneumonia are older and more likely to complain of cough/congestion or difficulty breathing than those with uncomplicated pneumococcal bacteremia. The use of a parenteral antibiotic at the initial visit for children with bacteremia-associated pneumococcal pneumonia resulted in a lower admission rate and more likely parental report of improved condition at follow-up than those for children treated only with an oral antibiotic.
authors.affiliation: Division of Emergency Medicine, Children's Hospital, Boston, MA 02115, USA. chumpa_a@a1.tch.harvard.edu
authors.forename: A
authors.initials: A
authors.lastname: Chumpa
authors.forename: R G
authors.initials: RG
authors.lastname: Bachur
authors.forename: M B
authors.initials: MB
authors.lastname: Harper
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use; D016470:Bacteremia / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007267:Injections; D008297:Male; D011018:Pneumonia, Pneumococcal / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy*; D012189:Retrospective Studies
chemical_list: D000900:Anti-Bacterial Agents