Pneumococcal bacteremia in childhood: a 6-year experience in a community hospital.

OBJECTIVE: To review the clinical and laboratory findings in children with pneumococcal bacteremia during a 6-year period between 1989 and 1995.

DESIGN: Retrospective review of medical records identified from computer-generated blood culture records.

SETTING: Hurley Medical Center in Flint, Mich, a community teaching hospital affiliated with Michigan State University.

MEASUREMENTS: Data concerning age, gender, race, clinical findings, laboratory features, nature of antibiotic therapy, source of bacteremia, and outcome were obtained from patient medical records.

RESULTS: Most (68%) of the children with pneumococcal bacteremia were <2 years of age. About 50% of the cases of invasive pneumococcal disease in childhood occurred between February and May. Focal source of bacteremia was as follows: 11.5% had meningitis, 37% had pneumonia, 30% had otitis media, and 33% had no focal source. Overall, 60% of children were African-Americans, although in children with meningitis, whites were predominant (p<0.04). Leukocytosis was present in 81% and bandemia >1,500/microL was present in 53% of children. The overall mortality was 1.6% with a case fatality rate for meningitis of 14%. Penicillin resistance was found in 6.5% of pneumococcal isolates, although during 1 study year (1993), 17% of all pneumococcal isolates from all sources in the same hospital were found to be penicillin resistant.

CONCLUSIONS: Clinical and laboratory findings seen in children with pneumococcal bacteremia at a community hospital are presented with a review of literature. Pneumococci isolated from sterile body sites were found to be less resistant to antibiotics compared with those isolated from nonsterile body sites.