Pneumococcal Bacteremia in Adults over a to-Year Period at University Hospital, Leiden

Abstract

The medical records on all cases of pneumococcal bacteremia in adults at the University Hospital, Leiden, over a 10-year period (1976)(1977)(1978)(1979)(1980)(1981)(1982)(1983)(1984)(1985)(1986) were retrospectively reviewed. In this series of 147 episodes (an annual incidence of 0.8 episodes/10,000 adults), overall mortal ity was 25.9%. Factors significantly related to a higher mortality rate were shock, respira tory insufficiency, preexisting renal failure, and rapidly fatal underlying disease. Several laboratory abnormalities -such as a low percentage of band forms, an elevated level of serum lactate dehydrogenase, and hyperbilirubinemia -were significantly related to a poor outcome. Multilobar pneumonia and meningitis were both associated w'ith high mortal ity, although not to a statistically significant degree. Discriminant analysis showed the presence of shock as the most powerful predictive factor of death. Surprisingly, prior splenectomy did not correlate with higher mortality. Treatment with p-lactam antibiotics favorably influenced the outcome of illness in patients with ultimately fatal and nonfatal underlying disease, while the use of these agents in patients w'ith rapidly fatal underlying disease did not correlate significantly with a good prognosis.

Mortality from invasive pneumococcal pneumonia in the era of antibiotic resistance, 1995-1997

“…The presence of severe underlying disease is the other factor that consistently predicts mortality from invasive pneumococcal pneumonia. [6][7][8]10,12,25 Our data also support more recent observations that mortality from invasive pneumococcal pneumonia is not increased among patients with HIV infection without AIDS. 23,24 Case-fatality rates also varied significantly by geographic location, with the lowest rate in Maryland and the highest in Toronto/Peel.…”

“…[5][6][7][8] In recent studies, the case-fatality rates for bacteremic pneumococcal pneumonia ranged from 7% to 35%. 5,[8][9][10][11][12] The prevalence of antibiotic-resistant S pneumoniae has increased over the last decade in the United States. The proportion of pneumococci nonsusceptible to penicillin has reached 35% in some areas.…”

Enhanced decision support for policy makers using a web interface to health-economic models—Illustrated with a cost-effectiveness analysis of nation-wide infant vaccination with the 7-valent pneumococcal conjugate vaccine in the Netherlands

“…Of these cases, 50% of total bacteremia cases were assumed to cause morbidity, whereas the other 50% was assumed not to be harmful in nature (Personal communication Dr. L. Spanjaard, Netherlands Reference Laboratory Meningitis, RIVM/AMC). The mortality rate for serious cases of pneumococcal bacteremia and meningitis among adults in the Netherlands was assumed to be 25.9% [26] and 30.4%, respectively [27]. Indirect costs due to mortality were calculated using the friction cost method with a friction period of 154 days [24].…”

“…a Bos et al conducted a expert panel meeting in 1999 with representatives of the pediatric departments of most academic hospitals in the Netherlands. Table 3 Estimated mean and standard error for parameters used in the multivariate probabilistic sensitivity analysis with the appropriate references Parameter description Mean SE Vaccine efficacy against IPD at age 4-11 months-partially vaccinated individuals a [13] 0.857 0.2551 Vaccine efficacy against IPD after age 12 months-fully vaccinated individuals a [13] 0.939 0.0482 The effectiveness of the vaccine against episodes of otitis media (all causative agents) a [13] 0.064 0.0122 The effectiveness of the vaccine against clinical pneumonia (all causative agents) a [28] 0.06 0.0242 Reduction in total cases of IPD in unvaccinated age-group 20-39 a [16] 0.32 0.0408 Reduction in total cases of IPD in unvaccinated age-group 40-64 a [16] 0.08 0.0357 Reduction in total cases of IPD in unvaccinated age-group 65 and older a [16] 0.18 0.0332 Mortality of pneumococcal meningitis cases in children (population age mean 8 months) b [3] 0.169 0.0409 Mortality of pneumococcal bacteremia cases in children (population age < 15 years old) b [4] 0.06 0.0061 Mortality of pneumococcal meningitis cases in adults b [27] 0.304 0.0245 Mortality of bacteremia cases in adults b [26] 0.259 0.036 Serotype coverage of PCV7 of meningitis cases in the Netherlands b [21] 0.671 0.025 Serotype coverage of PCV9 of meningitis cases in the Netherlands b [21] 0.683 0.0247 Serotype coverage of PCV10 of meningitis cases in the Netherlands b [21] 0.782 0.0219 Serotype coverage of PCV13 of meningitis cases in the Netherlands b [21] 0.861 0.0184 Serotype coverage of PCV7 of bacteremia cases in the Netherlands b [21] 0.595 0.0256 Serotype coverage of PCV9 of bacteremia cases in the Netherlands b [21] 0.682 0.0243 Serotype coverage of PCV10 of bacteremia cases in the Netherlands b [21] 0.78 0.0216 Serotype coverage of PCV13 of bacteremia cases in the Netherlands b [21] 0 The distribution parameters are calculated by method of moments estimation. This requires an estimate of the mean and the standard error (SE).…”

Use of influenza and pneumococcal vaccines in people with diabetes.

“…Because age has such a stro n g impact on the frequency of diabetes re p o rt e d in cohorts of bacteremic patients (102) and m o rtality in others (13)(14)(15)(92)(93)(94)98,(101)(102)(103)(104), it is difficult to assess the impact of diabetes as an independent risk factor. Case fatality rates for children are typically low (94,97,100). Adults ( 50 years of age) have re p o rted fatality rates of 2.4% compared with 15% in patients 50 years of age (103).…”