Pneumococcal bacteremia in adults: a 14-year experience in an inner-city university hospital.

We retrospectively reviewed 304 episodes of pneumococcal bacteremia in 293 adults to compare the clinical features, prognostic factors, and case-fatality rate associated with this illness to those in previous studies. We studied patients at an inner-city university hospital who had pneumococcal bacteremia from January 1980 through December 1993. We analyzed patient demographics, risk factors for pneumococcal infection, pneumococcal vaccination status, initial vital signs, findings on chest roentgenograms, arterial blood gases, and laboratory values. Ninety-six percent of our study population was African American and 61% were male; pneumococcal vaccination was documented for 2%. The case-fatality rate in our study was 36%. Older age, lower mean arterial pressure, lower mean temperature, higher respiratory rate, multilobar pneumonia, leukopenia, low platelet count, hypoalbuminemia, low arterial pH, low arterial oxygen tension, and high arterial carbon dioxide tension were associated with higher mortality. Our study suggests that mortality due to pneumococcal bacteremia has not changed significantly in the last 6 decades, that the number of patients in high-risk groups who are receiving pneumococcal vaccine is insufficient, and that higher mortality can be predicted from the history, vital signs, and laboratory values at initial presentation.