Adult bacteremic pneumococcal pneumonia in a community teaching hospital, 1992-1996. A detailed analysis of 108 cases.

OBJECTIVES: To review the clinical and laboratory findings of 108 adult patients with bacteremic pneumococcal pneumonia admitted to a community hospital and to determine the value of sputum Gram stains and cultures in the diagnosis of pneumococcal pneumonia in this setting.
METHODS: Using the laboratory logbooks to identify adult inpatients with pneumococcal bacteremia from January 1, 1992, to June 30, 1996, were reviewed medical records.
RESULTS: We found 108 patients. There was an apparent increase in prevalence from 1995 to 1996 compared with 1992 to 1994. Patients included 44 men and 64 women. Ages ranged from 20 to 95 years (median, 70 years). The fatality rate was 24.1% and increased with advancing age (no patient younger than 45 years died, and 36.8% of patients aged 85-95 years died). Cigarette smoking, cardiovascular disease, chronic obstructive lung disease, malignant disease, and diabetes mellitus were major underlying conditions. Fever, dyspnea, and cough were the most common presenting symptoms. Sputum Gram stain was useful in the diagnosis when moderate to abundant Gram-positive diplococci were seen. Sputum culture was less useful. Factors associated with higher fatality rate were being 65 years of age or older, APACHE II (Acute Physiologic and Chronic Health Evaluation II) score greater than 15, intensive care unit admission, low or normal leukocyte count, thrombocytopenia, renal dysfunction, diffused infiltrates on chest radiography, bilateral pneumonia, and sputum culture positive for Streptococcus pneumoniae.
CONCLUSIONS: We found a recent increase in the prevalence of bacteremic pneumococcal pneumonia in adults. Gram stain of sputum is useful, but sputum culture is less sensitive in the diagnosis of pneumococcal pneumonia. The fatality rate remains high. More effort should be made at prevention using pneumococcal immunization.