We performed a prospective study of all infections with Streptococcus pneumoniae documented during a 22-month period at our hospital. A total of 163 clinically significant strains of S. pneumoniae were isolated from 139 patients whose ages ranged from 8 days to 91 years (mean +/- SD, 42.6 years +/- 26.8 years). Twenty percent of the patients had cancer, and 18% were infected with the human immunodeficiency virus. Pneumococcal infection was nosocomially acquired in one-fourth of cases. One-third of patients had nonpneumonic disease. A wide range of serotypes were isolated, and 42.5% of all strains were nonsusceptible--i.e., showed either intermediate or high-level resistance--to penicillin. The rates of resistance to chloramphenicol, erythromycin, and tetracycline were 23%, 10.8%, and 48.2%, respectively. Twenty-two percent of the infected patients died, with a 15.8% mortality directly attributable to pneumococcal infection. Factors associated with infection by strains of S. pneumoniae not susceptible to penicillin included an age of less than or equal to 10 years, immunosuppression, the presence of a rapidly fatal underlying disease, previous antimicrobial therapy, and infection by serotypes 14 and 23. All clinically significant isolates of S. pneumoniae should be submitted for antimicrobial susceptibility studies, and, whenever a high prevalence of resistance to penicillin and macrolides is detected, the use of these well-established empirical therapeutic regimens should be reconsidered.

The incidence and clinical characteristics of mycobacteriosis in patients attending the nephrology department in a hospital in Madrid, Spain, during a 30-month period were analysed retrospectively. Twenty-two new cases of tuberculosis were detected among 525 patients studied. No cases of clinically significant atypical mycobacteriosis were found. The estimated overall annual incidence of tuberculosis in these patients was 259 cases per 100,000 population, which is much higher than the national annual incidence in Spain of 35 per 100,000 population. Most cases were asymptomatic when diagnosed and extrapulmonary involvement was the rule (86% of all patients). In areas with a high prevalence of tuberculosis, renal patients in high-risk groups (renal transplant recipients, haemodialysis and CAPD patients) should be examined periodically to exclude silent infection.

The HIV-infected patient is at increased risk for pneumococcal pneumonia and bacteremia. Patients younger than 40 years of age who present with pneumococcal pneumonia should be considered for HIV testing, since it may be the first manifestation of HIV infection. Specific antimicrobial therapy is curative in the majority of HIV-infected patients.

No abstract

No abstract