Nosocomial pneumococcal bacteremia.

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.