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August 1986

Nosocomial Pneumococcal Bacteremia

Author Affiliations

From the Infectious Disease Section, Medical Service, Veterans Administration Medical Center (Drs Alvarez, Guarderas, and Berk and Mr Shell) and the Department of Internal Medicine, Quillen-Dishner College of Medicine (Drs Alvarez, Guarderas, and Berk and Ms Holtsclaw-Berk), Johnson City, Tenn.

Arch Intern Med. 1986;146(8):1509-1512. doi:10.1001/archinte.1986.00360200059010

• In five years we studied 56 episodes of pneumococcal bacteremia. Twenty-three (41%) were nosocomial and 33 (59%) community acquired. Most of our patients were elderly men with multiple underlying diseases; however, those patients with nosocomial infections had a significantly higher incidence of malignant neoplasms (57% vs 24%), poor functional status (70% vs 25%), and ultimately fatal underlying disease (61% vs 21%). Alcoholism was more common among the patients with community-acquired bacteremia (45% vs 17%). Nosocomial infections carried a significantly higher overall mortality (73.9% vs 45.4%). The mortality directly related to the pneumococcal bacteremia was also higher (52% vs 39%), but not significantly. Most of the isolated strains were serotypes present in the new pneumococcal vaccine, which only one study patient had received. Mixed pneumococcal bacteremia with gram-negative bacilli was more frequent in nosocomial infections. Streptococcus pneumoniae can be a nosocomial pathogen in elderly, debilitated patients. Pneumococcal vaccination should be incorporated in a hospital-based prevention program for high-risk patients.

(Arch Intern Med 1986;146:1509-1512)

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