Objective: To describe the epidemiology of invasive and non-invasive pneumococcal disease during a 5-year period in a major hospital in Bahrain.   Design and Setting: Retrospective study of cases of pneumococcal diseases among patient ≥ 14 years old during a five-year period (2010-2014), who attended Salmaniya Medical Complex, Bahrain.   Patients and Methods: Laboratory data was obtained on Streptococcus pneumoniae isolates. Patients ≥14 years old of age, both inpatient and outpatient with cultures positive for Streptococcus pneumoniae were included. Only samples from blood, cerebrospinal fluid (CSF), pleural fluid, sputum, deep tracheal aspirate (DTA), bronchial wash, eye discharge and middle ear fluid were included. Demographics and clinical records from medical files were then reviewed.   Results: A total of 130 culture samples met the inclusion criteria and were analyzed. One-hundred twenty-six patients with pneumococcal disease were identified; with 65% being non-invasive and 35% being invasive pneumococcal disease. Overall, non-bacteremic Pneumonia was the most frequent manifestation, followed by bacteremia. Pneumococcal disease was more common among male patients (62.7%). Mean age was 57.67 (15-95 years). The most common comorbidities were hypertension, Diabetes Mellitus followed by cardiovascular disease. Twenty-seven patients received mechanical ventilation during their admission, 13 patients were admitted to the intensive care unit, and 6 patients developed para-pneumonic effusion as a complication. In-hospital Mortality rate was 13.5%.     Conclusion:  This study supports the current literature where pneumococcal infection is more prevalent in elderly and those with comorbidities. Mortality was related to age, certain chronic medical illness, admission to intensive care unit and need for mechanical ventilation.

Objective: To describe the epidemiology of invasive and non-invasive pneumococcal disease during a 5-year period in a major hospital in Bahrain. Design and Setting:This retrospective study investigates cases of pneumococcal diseases among patient ≥14 years old during a fiveyear period (2010)(2011)(2012)(2013)(2014), who attended Salmaniya Medical Complex, Bahrain. Patients and Methods:Laboratory data were obtained from inpatient and outpatient with cultures positive for Streptococcus pneumoniae. Demographics and clinical records from medical files of patients were then reviewed.Results: A total of 144 culture positive S. pneumoniae representing 139 patients met the inclusion criteria. Ninety-five patients had noninvasive pneumococcal disease and 44 patients had invasive pneumococcal disease. Pneumococcal disease was more common among male patients (58.99%) with mean age of 56-year (15-95). The most common comorbidities were hypertension, Diabetes Mellitus followed by cardiovascular disease. Twenty-seven patients received mechanical ventilation during their admission, and 13 patients were admitted to the intensive care unit. The overall mortality rate recorded in our centre was 14.4%. IntroductionStreptococcus pneumoniae, is a Gram-positive diplococcus, causes a spectrum of diseases; ranging from invasive to non-invasive pneumococcal disease (NIPD) [1]. Invasive pneumococcal disease (IPD) refers to isolation of S. pneumoniae from a normally sterile body sites like blood, cerebrospinal fluid (CSF) or pleural fluid [2]. IPD can manifest as serious diseases such as bacteremia, meningitis and bacteremic pneumonia. NIPD includes the commonly occurring diseases like sinusitis, acute otitis media and non-bacteremic pneumonia. S. pneumoniae is considered the most common cause of community acquired pneumonia (CAP) [1].Risk factors for developing pneumococcal disease include age, coexisting medical illness such as chronic obstructive pulmonary disease (COPD), chronic heart disease and Diabetes Mellitus [3] The risk of IPD and sepsis has been reported to be increased among patients older than 65 years old with chronic underlying conditions. S. pneumoniae has been shown to occur more frequently in immunocompromised individuals, and possibly with more frequent relapses [4].Gram stains and culture are routinely used as the first step to identify S. pneumoniae, while new laboratory methods have been introduced such as antigen and nucleic acid detection assays [5][6]. In the United States alone, 4 million pneumococcal disease episodes occur annually with 22,000 deaths among adults [7]. In addition, over 600,000 cases are admitted each year to the hospitals with pneumococcal pneumonia [8]. S. pneumoniae is responsible for considerable mortality reaching as high as 60% in elderly patients with pneumococcal bacteremia and 22% in adults with pneumococcal meningitis [1].This study aims to provide an overview of the burden of culture-proven pneumococcal disease in patients 14 years of age and older who were admitted to Salman...