title: Clinical and economic burden of invasive pneumococcal disease in adults: a multicenter hospital-based study.
abstract: BACKGROUND
  Streptococcus pneumoniae causes a broad spectrum of illnesses ranging from mild upper respiratory tract infections to invasive pneumococcal disease (IPD). Quantitative data on the burden of pneumococcal disease, important for the establishment of appropriate vaccination strategies, is currently lacking in adults.
  
  
  METHODS
  This multicenter, retrospective cohort study was designed to estimate the clinical and economic burden of IPD in adults over the last decade. Data were collected from patients with IPD at 10 university hospitals in South Korea. We estimated the proportion of IPD among all hospitalized patients, the case fatality rate, and the direct medical costs of IPD. Data were further analyzed according to age and risk groups.
  
  
  RESULTS
  During the study period, 970 patients with IPD were identified. The mean age for all patients was 60.9 years; patients aged 50-64 years (33.0%) were most numerous, followed by those aged 65-74 years (27.4%). Overall, the proportion of IPD was 0.36 cases/1000 hospitalized patients and the case fatality rate was 30.9%, which increased significantly with age (p < 0.01). The mean direct medical costs were estimated to be US $7,452 without a difference between age and risk groups. On multivariate analysis, old age, advanced ECOG performance status, bacteremic pneumonia, and nosocomial infection were independent risk factors of 30-day case fatality.
  
  
  CONCLUSIONS
  The clinical disease burden of IPD increased significantly with age and direct medical costs from IPD were substantial, regardless of age and co-morbid conditions. The current age-based vaccination strategy appears to be appropriate.
authors: Division of Infectious Disease, Department of Internal Medicine, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul 152-703, Republic of Korea.
authors: Joon Young
authors: JY
authors: Song
authors: Jun Yong
authors: JY
authors: Choi
authors: Jin Soo
authors: JS
authors: Lee
authors: In-Gyu
authors: IG
authors: Bae
authors: Young Keun
authors: YK
authors: Kim
authors: Jang Wook
authors: JW
authors: Sohn
authors: Yu Mi
authors: YM
authors: Jo
authors: Won Suk
authors: WS
authors: Choi
authors: Jacob
authors: J
authors: Lee
authors: Kyung Hwa
authors: KH
authors: Park
authors: Woo Joo
authors: WJ
authors: Kim
authors: Hee Jin
authors: HJ
authors: Cheong
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D015999:Multivariate Analysis; D011008:Pneumococcal Infections / Q000175:diagnosis / Q000191:economics* / Q000453:epidemiology* / Q000382:microbiology; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013296:Streptococcus pneumoniae / Q000187:drug effects / Q000302:isolation & purification
chemical_list: D000900:Anti-Bacterial Agents
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