title: Comparison of clinical features, antimicrobial susceptibility, serotype distribution and outcomes of patients with hospital- and community-associated invasive pneumococcal disease.
abstract: Hospital-associated invasive pneumococcal disease (HA-IPD) is infrequently reported. A retrospective surveillance of IPD in a medical centre in Taiwan was conducted from 2000 to 2008 to compare the clinical and microbiological characteristics of HA-IPD and community-associated IPD (CA-IPD). HA-IPD was identified in 37 patients, comprising 12.3% of the 302 hospitalised patients with IPD. Patients with HA-IPD were more likely to have solid-organ cancer (40.5% vs. 16.6%; P=0.001) or to have received immunosuppressive therapy (56.8% vs. 26.8%; P<0.001). The 30-day mortality rate of HA-IPD was significantly higher than that of CA-IPD (40.5% vs. 16.2%; P=0.001). Age >or=65 years [odds ratio (OR)=2.10; P=0.033], HA-IPD (OR=2.90; P=0.009) and liver cirrhosis (OR=3.19; P=0.009) were independent predictors of 30-day mortality. No significant differences in serotype distribution or in susceptible rates to penicillin (18.2% vs. 32.6%; P=0.14) and cefotaxime (60.6% vs. 67.8%; P=0.53) were found between HA-IPD and CA-IPD isolates. Similar prevalences of the serotypes included in the pneumococcal vaccines were found in isolates from patients with HA-IPD and CA-IPD. Among patients with HA-IPD and CA-IPD, 26 (78.8%) and 172 (73.2%) (P=0.45) had isolates of serotypes included in the 7-valent pneumococcal conjugate vaccine, and 30 (90.9%) and 224 (95.3%) (P=0.96) had isolates of serotypes included in the 23-valent pneumococcal polysaccharide vaccine, respectively. In summary, this study found that HA-IPD and CA-IPD were not significantly different with regard to serotype distribution and antimicrobial susceptibility in Taiwan. Patients with HA-IPD have a higher mortality rate, and pneumococcal vaccination for patients at increased risk for HA-IPD should be encouraged.
authors.affiliation: Department of Internal Medicine, Taipei County Hospital, Taipei County, Taiwan.
authors.forename: Sheng-Hsiang
authors.initials: SH
authors.lastname: Lin
authors.forename: Wan-Hsiu
authors.initials: WH
authors.lastname: Liao
authors.forename: Chih-Cheng
authors.initials: CC
authors.lastname: Lai
authors.forename: Che-Kim
authors.initials: CK
authors.lastname: Tan
authors.forename: Chun-Hsing
authors.initials: CH
authors.lastname: Liao
authors.forename: Yu-Tsung
authors.initials: YT
authors.lastname: Huang
authors.forename: Cheng-Yi
authors.initials: CY
authors.lastname: Wang
authors.forename: Po-Ren
authors.initials: PR
authors.lastname: Hsueh
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D002439:Cefotaxime / Q000494:pharmacology; D017714:Community-Acquired Infections / Q000150:complications / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality; D003428:Cross Infection / Q000150:complications / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D008103:Liver Cirrhosis / Q000150:complications; D008297:Male; D009369:Neoplasms / Q000150:complications; D010406:Penicillins / Q000494:pharmacology; D011008:Pneumococcal Infections / Q000150:complications / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality; D022242:Pneumococcal Vaccines / Q000276:immunology; D012189:Retrospective Studies; D012307:Risk Factors; D012703:Serotyping; D013296:Streptococcus pneumoniae / Q000145:classification* / Q000187:drug effects*; D013624:Taiwan / Q000453:epidemiology; D016896:Treatment Outcome; D018074:Vaccines, Conjugate / Q000276:immunology
chemical_list: D000900:Anti-Bacterial Agents; D007166:Immunosuppressive Agents; D010406:Penicillins; D022242:Pneumococcal Vaccines; D018074:Vaccines, Conjugate; D002439:Cefotaxime