Defining the Population-Based Burden of Nosocomial Pneumococcal Bacteremia

Abstract

Background: The characteristics, risk factors, and outcome of patients with nosocomial pneumococcal bacteremia (NPB) have not been described in large, population-based studies. Methods: All episodes of invasive pneumococcal infections reported by Finnish clinical microbiology laboratories (positive blood or cerebrospinal fluid culture) from January 1, 1995, through December 31, 2002, were linked to data in national health care registries and vital statistics to obtain information on the patient's preceding hospitalizations, comorbidities, and outcome of illness. Pneumococcal bacteremia was defined as nosocomial if the first positive blood culture was obtained more than 2 days after hospital admission, or if the patient had been hospitalized for more than 2 days within 7 days of the first positive blood culture. Results: Information on hospital admission was available for 4217 of 4357 persons (96.8%) with invasive pneumococcal infections. We identified 387 NPBs (9.7%) among 3973 pneumococcal bacteremias. Patients with NPB were older (median age, 67 years vs 52 years; PϽ.001) and were more likely to have at least 1 high-risk condition (other than age Ն65 years), for which 23-valent pneumococcal polysaccharide vaccine is recommended (59.2% vs 34.6%; PϽ.001), compared with patients who had communityassociated pneumococcal bacteremias. The case fatality proportion at 28 days was higher in patients with NPB than in those with community-associated pneumococcal bacteremias (23.8% vs 10.8%; PϽ.001). Pneumococcal serotypes included in 23-valent polysaccharide vaccine and 7-valent conjugate vaccine caused 71.5% and 46.1% of NPBs, respectively. Conclusions: A substantial proportion of pneumococcal bacteremias are health care associated. The high prevalence of conditions for which pneumococcal polysaccharide vaccine is recommended provides opportunities for strengthening prevention efforts in these patients at high risk of illness and death.

Epidemiology of antimicrobial resistance in bloodstream infections

“…28 Only 10% of cases are related with healthcare associated infections. 45 One of the important aspects of invasive pneumococcal infections related with bacteremia is that the universal use of conjugate pneumococcal vaccine in infants and more recently in the adult population: Decreased exposure from infants led the adult population have a lower incidence of invasive pneumococcal disease which is also described as herd protection. 46 In the US, >90% of all pneumococci causing infections other than meningitis are sensitive (<0.06 mg/L) and only 2% are resistant (>2 mg/L) to parenteral penicillin or oral amoxicillin.…”

Population-Based Epidemiology and Microbiology of Community-Onset Bloodstream Infections

“…Although the current annual incidence of community-onset Streptococcus pneumoniae BSI likely ranges between 10 and 20 per 100,000 in most Western countries, it is difficult to precisely define an overall rate, for several reasons (4,5). First, this organism usually causes community-onset disease, with only approximately 10% of cases overall showing hospital-onset disease (144). Studies to date have not typically differentiated between community-and hospital-onset disease.…”

Comparison of clinical features, antimicrobial susceptibility, serotype distribution and outcomes of patients with hospital- and community-associated invasive pneumococcal disease

“…Primary pneumococcal bacteraemia was defined as isolation of pneumococcus from blood without an identified focus. IPD was defined as hospital-associated if the first positive sterile site culture was obtained >48 h after hospital admission or if the patient had been hospitalised for >2 days within 7 days of the first positive sterile site culture [1].…”

“…Streptococcus pneumoniae is a well-known cause of communityacquired infections, and a substantial proportion of pneumococcal bacteraemias are hospital-acquired [1][2][3][4][5][6]. Nosocomial pneumococcal disease is associated with the emergence of antibiotic-resistant strains [7][8][9][10] and carries a higher mortality rate than communityassociated pneumococcal infection [1,4,11].…”

“…Nosocomial pneumococcal disease is associated with the emergence of antibiotic-resistant strains [7][8][9][10] and carries a higher mortality rate than communityassociated pneumococcal infection [1,4,11]. However, hospitalassociated pneumococcal disease has received little attention and thorough comparison of the characteristics of hospitalassociated and community-associated pneumococcal disease has been reported in only a few studies [1,10,12,13]. period from January 2000 to December 2008.…”