Streptococcus pneumoniae bacteremia in Prapokklao Hospital.

Abstract

Objective : To study clinical presentation of S. pneumoniae bacteremic patients in Prapokklao Hospital. To report the incidence of drug resistant Streptococcus pneumoniae isolated from blood culture in Prapokklao Hospital. To examine the effect of resistance to penicillin and cephalosporin on the mortality of patients with S. pneumoniae bacteremia.

Methods : Retrospective chart review of patients with hemoculture positive for S. pneumoniae from January 2000 to December 2002. All S.pneumoniae isolated from blood were determined for sensitivity to penicillin by useing oxacillin disk diffusion test and determined MIC of penicillin and cefotaxime by E -test.

Result : S. pneumoniae was isolated from blood in 45 patients within 3 year, average 15 cases per year. Male is more common than female M : F = 2 : 1, average age 35.6 years range from 5 month to 81 years. Most common age group was < = 10 years(24.4 percent),Most patients had comorbid condition, HIV infection was the most common underlying disease (26.7 percent) followed by alcoholic abuse (13.3 percent). Fever was the most common chief complain (57.8 percent) follow by respiratory symptoms (35.6 percent) and gastrointestinal symptoms (28.9 percent). Most patients (88.9 percent) had other side of infection, pneumonia
(57.6 percent), diarrhea (17.8 percent) and meningitis (15.6 percent). Among the 45 patients 13 (37.5 percent) had penicillin resistant strains of S. pneumoniae minimal inhibitory concentration (MIC) of penicillin > = 0.12 to 3.0 μ g per milliliter and 7 patients (20 percent) had cephalosporin resistant strains (MIC of cefotaxime= 1.0 to 4.0 μ g per milliliter) mortality rate was 60.0 percents with penicillin - resistant strains, as compared with 32.0 percent in patient with penicillin sensitive strains (P = 0.107). Mortality rate was 71.4 percent with cephalopsporin resistant strains, compared with 36.4 percent in patients with cephalosporin
sensitive strain (P = 0.113). No relationship was seen between patient age,systolic blood pressure, comorbid conditions, leukocyte counts, sources of infection and overall mortality.Factors relating to increased mortality were a high respiratory rate (p=0.037); high blood urea level (p= 0:047) and the presence of consciouse change (p=0.023) on admission to hospital.The overall mortality rate was 48.9 percent.The mean MIC of penicillin is 0.392 μ g / ml is more than mean MIC of cefotaxime (0.290 μ g/ ml) significantly (P = 0.043) and MIC of penicillin is correlate with MIC of cefotaxine (P = 0.001),correlation coefficient was 0.948.

Conclusion : S. pneumoniae is not common in Prapokklao Hospital, and had high mortality rate. The drug resistant strains of S. pneumoniae had tendency to more mortality rate than sensitive strain but no statistic significance. Factors relating to increased mortality were a high respiratory rate; high blood urea level and the presence of consciouse change on admission to hospital. MIC of pencillin was higher than and correlated with MIC of cefotaxime.