title: Clinical outcomes of bacteremic pneumococcal infections in an area with high resistance.
abstract: In a retrospective study designed to gather information in a region with high antimicrobial resistance, the outcomes of 216 episodes of laboratory-confirmed pneumococcal bacteremia treated in Hong Kong between 1995 and 2001 were assessed. The patients had a mean age (+/-standard deviation) of 40+/-33.7 years. In all patients, the clinical diagnosis was confirmed by isolation of Streptococcus pneumoniae from blood (n=216), cerebrospinal fluid (n=7) and/or other sterile sites (n=12). Penicillin nonsusceptibility was found in 37.5% of the isolates (20.8% intermediate and 16.7% resistant). Penicillin nonsusceptibility was not a risk factor for inpatient mortality (p=0.7), nor did it affect duration of fever (p=0.4), requirement for intensive care unit admission (p=0.4) or development of suppurative complications (p=0.2). Advanced age (OR 11.3, 95%CI 4.5-28.2, p<0.01), critical illness (OR 11.3, 95%CI 4.5-28.2, p<0.001) and discordant therapy (OR 4.3, 95%CI 1.7-10.9, p<0.002) involving agents with poor anti-pneumococcal activity (but not penicillins and broad-spectrum beta-lactam agents) were significantly associated with mortality.
authors.affiliation: Centre of Infection and Department of Microbiology, Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Pokfulam Road, Pokfulam, Hong Kong Special Administrative Region, People's Republic of China. plho@hkucc.hku.hk
authors.forename: P L
authors.initials: PL
authors.lastname: Ho
authors.forename: T L
authors.initials: TL
authors.lastname: Que
authors.forename: T K
authors.initials: TK
authors.lastname: Ng
authors.forename: S S
authors.initials: SS
authors.lastname: Chiu
authors.forename: R W H
authors.initials: RW
authors.lastname: Yung
authors.forename: K W T
authors.initials: KW
authors.lastname: Tsang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016470:Bacteremia / Q000188:drug therapy* / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004351:Drug Resistance; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D011008:Pneumococcal Infections / Q000188:drug therapy* / Q000382:microbiology; D012189:Retrospective Studies; D013296:Streptococcus pneumoniae / Q000302:isolation & purification*; D016896:Treatment Outcome