title: Nosocomial bloodstream infections caused by Streptococcus pneumoniae.
abstract: A retrospective study of Streptococcus pneumoniae bacteraemia among adult patients in two large teaching hospitals in Spain identified 108 (10.6%) of 1,020 episodes as nosocomial pneumococcal bloodstream infections (NPBIs). Seventy-seven clinical records with sufficient data were available for analysis. The interval between admission and a positive blood culture was 3--135 days (median 17 days; interquartile range 8--27). The main underlying and predisposing conditions for NPBI were malignancy (31%), chronic obstructive pulmonary disease (28.6%), heart failure (16.9%), chronic renal failure (15.6%), liver cirrhosis (13%) and infection with human immunodeficiency virus (13%). Overall, 31.2% of patients developed severe sepsis, 11.7% septic shock, and 3.9% multi-organ failure. The main portals of entry were pneumonia (70.1%), meningitis (5.2%) and primary peritonitis (5.2%). Of the responsible serogroups, 78% were included in the 23-valent polysaccharide vaccine. Thirty-five (45.5%) patients died, with death considered to be related to the NPBI in 21 (27.3%) cases. Following multivariate analysis, factors that independently predicted death after adjusting for age were: ultimately fatal underlying disease (OR, 8.9; 95% CI, 0.8--94.3; p<0.001); rapidly fatal underlying disease (OR, 15.0; 95% CI, 2.8--81.3; p<0.001); heart failure (OR, 8.11; 95% CI, 1.1--60.8; p<0.03); inadequate empirical therapy (OR, 10.6; 95% CI, 1.2--97; p<0.003); a severe sepsis score (OR, 9.5; 95% CI, 1.9--47.0; p<0.001); and septic shock or multi-organ failure (OR, 63.7; 95% CI, 4.9--820.7; p<0.001). Adequate empirical therapy was an independent protective factor (OR, 0.05; 95% CI, 0.04--0.58; p<0.005), but the use of more than one antimicrobial agent was not.
authors.affiliation: Division of Clinical Microbiology, Hospital General Universitario 'Gregorio Marañón', Madrid, Spain. ebouza@microb.net
authors.forename: E
authors.initials: E
authors.lastname: Bouza
authors.forename: V
authors.initials: V
authors.lastname: Pintado
authors.forename: S
authors.initials: S
authors.lastname: Rivera
authors.forename: R
authors.initials: R
authors.lastname: Blázquez
authors.forename: P
authors.initials: P
authors.lastname: Muñoz
authors.forename: E
authors.initials: E
authors.lastname: Cercenado
authors.forename: E
authors.initials: E
authors.lastname: Loza
authors.forename: M
authors.initials: M
authors.lastname: Rodríguez-Créixems
authors.forename: S
authors.initials: S
authors.lastname: Moreno
mesh_terms: D000328:Adult; D016470:Bacteremia / Q000382:microbiology*; D001769:Blood / Q000382:microbiology; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D015658:HIV Infections / Q000150:complications; D006333:Heart Failure / Q000150:complications; D006784:Hospitals, Teaching; D006801:Humans; D007297:Inpatients; D007676:Kidney Failure, Chronic / Q000150:complications; D008103:Liver Cirrhosis / Q000150:complications; D008581:Meningitis / Q000382:microbiology; D009102:Multiple Organ Failure; D009369:Neoplasms / Q000150:complications; D010538:Peritonitis / Q000382:microbiology; D011008:Pneumococcal Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D011018:Pneumonia, Pneumococcal; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications; D012189:Retrospective Studies; D012307:Risk Factors; D012772:Shock, Septic; D013030:Spain / Q000453:epidemiology; D013296:Streptococcus pneumoniae / Q000302:isolation & purification*; D016896:Treatment Outcome