title: Clinical characteristics and outcome of patients with invasive pneumococcal disease, Puy-de-Dôme, France, 1994-1998.
abstract: A surveillance program for invasive pneumococcal disease was undertaken in Puyde-Dĵme, an administrative district of the region Auvergne in France, from 1 January 1994 to 31 December 1998. A total of 214 cases were identified. The annual incidence of invasive pneumococcal disease increased (P=0.04) from 5.5 in 1994 to 9.3 cases per 10(5) person-years in 1998. The highest incidences were for children <2 years of age (59.2 cases per 10(5) person-years) and for adults > or = 65 years (18 cases per 10(5) person-years). Clinical diagnoses, available in 200 patients, included acute pneumonia (62%), meningitis (10%), sepsis without focus (20%), and others (8%). The most frequent chronic medical conditions of the patients included smoking, alcoholism, cardiovascular and pulmonary diseases, and malignancies. Thirty-one percent of the isolates were nonsusceptible to penicillin. Penicillin resistance (MIC > or = 0.1 mg/l) was more frequent (P=0.02) in cancer patients. The overall case-fatality rate was 21.5%. Risk factors for death were age, sex, and underlying diseases of the patients, along with the severity of illness. These population-based findings should convince clinicians to offer pneumococcal vaccine to patients at high risk for invasive pneumococcal disease, thereby increasing vaccination coverage levels in France.
authors.affiliation: Infectious Diseases Department, Hôtel-Dieu, University Hospital of Clermont-Ferrand, France. hlaurichesse@chu-clermontferrand.fr
authors.forename: H
authors.initials: H
authors.lastname: Laurichesse
authors.forename: J P
authors.initials: JP
authors.lastname: Romaszko
authors.forename: L T
authors.initials: LT
authors.lastname: Nguyen
authors.forename: B
authors.initials: B
authors.lastname: Souweine
authors.forename: V
authors.initials: V
authors.lastname: Poirier
authors.forename: D
authors.initials: D
authors.lastname: Guólon
authors.forename: M
authors.initials: M
authors.lastname: André
authors.forename: M
authors.initials: M
authors.lastname: Ruivard
authors.forename: C
authors.initials: C
authors.lastname: De Champs
authors.forename: D
authors.initials: D
authors.lastname: Caillaud
authors.forename: A
authors.initials: A
authors.lastname: Labbé
authors.forename: J
authors.initials: J
authors.lastname: Beytout
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D002648:Child; D002675:Child, Preschool; D004351:Drug Resistance; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D011008:Pneumococcal Infections / Q000453:epidemiology*; D011159:Population Surveillance; D012307:Risk Factors; D012703:Serotyping; D013296:Streptococcus pneumoniae / Q000145:classification / Q000187:drug effects