Bacteremic pneumococcal pneumonia in one American city: a 20-year longitudinal study, 1978–1997

doi:10.1016/S0002-9343(99)00098-4

The American Journal of Medicine

Volume 107, Issue 1, Supplement 1, 26 July 1999, Pages 34-43

https://doi.org/10.1016/S0002-9343(99)00098-4 Get rights and content

Abstract

A surveillance of bacteremic pneumococcal pneumonia was conducted in Huntington, West Virginia, from 1978 to 1997 to investigate case-fatality rates, incidence of disease, capsular types, and antibiotic usage. Our study population comprised consecutive inpatients admitted to the hospitals in Huntington, West Virginia, and included 45 children younger than 15 years and 328 adults. All blood isolates were serotyped by capsular swelling procedures; clinical characteristics, treatment, and outcome for all patients were abstracted from hospital charts. The overall case-fatality rate was 20.3%, with most deaths occurring among adults older than 50 years. Case-fatality rates peaked at 37.7% among patients 80 years of age and older. Only 1 of 45 (2.2%) children died. Case-fatality rates declined in each successive 5-year period, from 30.2% in 1978–1982 to 15.6% in 1993–1997. In that same period, incidence rates increased severalfold among children younger than 4 years to 44.5 cases per 100,000 population and among adults 70 years and 80 years of age and older to 38.5 and 76.2 cases per 100,000, respectively. Of the 34 serotypes isolated, 10 accounted for two thirds of the cases of pneumonia: 1, 4, 9, 14, 3, 6, 12, 5, 23, and 19 (in rank order). Chronic renal disease and arteriosclerotic heart disease increased the risk of death. Treatment regimens that included a macrolide and a penicillin or cephalosporin resulted in the lowest case-fatality rate in adults older than 50 years: 6% in 1993–1997. In conclusion, as bacteremic pneumococcal pneumonia evolved over time, the case-fatality rate decreased, its incidence increased, predominant capsular types changed, and treatment regimens that included a macrolide resulted in the lowest fatality rates.

Section snippets

Population

Our study population comprised consecutive adults (15 years of age and older) and children (14 years of age and younger) with bacteremic pneumococcal pneumonia treated at the hospitals in Huntington, West Virginia, which were affiliated with the Marshall University School of Medicine during epidemiologic years 1978–1997 (an epidemiologic year encompassed July 1 through June 30). Pneumococcus was isolated from the blood or pleural fluid. The hospitals surveyed included two community tertiary

Size of study group

Between 1978 and 1997, 600 persons with invasive pneumococcal disease were admitted to the three affiliated hospitals. The study group comprised 423 persons with bacteremic pneumococcal pneumonia: 378 adults, of whom 85 died, and 45 children, of whom 1 died. A subgroup of 279 persons (244 adults and 35 children) lived in Huntington and its three surrounding counties; this subgroup was used to calculate incidence rates of bacteremic pneumococcal pneumonia.

Case-fatality rate and risk factors

During the study period, most cases of

Discussion

Our epidemiologic study of bacteremic pneumococcal pneumonia in one US city, Huntington, West Virginia, during the 20 years 1978–1997, provides a unique view of the changing nature of bacteremic pneumococcal pneumonia from four perspectives: declining case-fatality rates over time; increasing incidence over time; changing prevalence of predominant capsular types; and evolving antibiotic treatment regimens in the community, especially the effectiveness of combination antibiotic therapy that

Acknowledgements

This article honors Bob Austrian, a modern-day medical visionary. Bob Austrian alone saw the extreme importance of serious pneumococcal pneumonia clearly, when others believed that the introduction of penicillin for its treatment signaled the end of this threat. His seminal investigation at Kings County Hospital in the early 1950s awakened the medical community to the importance of bacteremic pneumococcal pneumonia as a killer in the postpenicillin era. His personal imprint on the quest for a

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Original ArticlesBacteremic pneumococcal pneumonia in one American city: a 20-year longitudinal study, 1978–1997

Abstract

Section snippets

Population

Size of study group

Case-fatality rate and risk factors

Discussion

Acknowledgements

Biologicals

Chest

Lancet

Am J Med Sci

Chest

Chest

Vaccine

Pneumococcal infection

Curr Opin Infect Dis

The enduring pneumococcusunfinished business and opportunities for the future

Microb Drug Resist

Epidemiology and in vitro susceptibility of drug-resistant Streptococcus pneumoniae

Pediatr Infect Dis J

Antimicrobial resistance in Streptococcus pneumoniaean overview

Clin Infect Dis

Bacteremia with Streptococcus pneumoniae. Implications for therapy and prevention. Franklin County Pneumonia Study Group

JAMA

Pneumococcal bacteremia in Charleston County, South Carolina. A decade later

Arch Intern Med

Pneumococcal bacteremia in Monroe County, New York

Am J Public Health

Pneumococcal bacteremia in adultsa 14-year experience in an inner-city university hospital

Clin Infect Dis

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

Arch Intern Med

Pneumococcal bacteremia with especial reference to bacteremic pneumococcal pneumonia

Arch Intern Med

Incidence, capsular types, and antibiotic susceptibility of invasive Streptococcus pneumoniae in Sweden

Clin Infect Dis

Rising rate of pneumococcal bacteremia at the Children’s Hospital of Philadelphia

Pediatr Infect Dis J

Original Articles
Bacteremic pneumococcal pneumonia in one American city: a 20-year longitudinal study, 1978–1997