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Recurrent Pneumococcal Bacteremia
Risk Factors and Outcomes
Glenn S. Turett, MD;
Steve Blum, PhD;
Edward E. Telzak, MD
Arch Intern Med. 2001;161:2141-2144.
Background Recurrent pneumococcal bacteremia receives infrequent mention in the
literature, usually in association with patients who are immunocompromised.
Objective To examine recurrent cases of pneumococcal bacteremia to determine risk
factors and outcomes (mortality rates and emergence of resistance) associated
with recurrences.
Methods We retrospectively reviewed all cases of pneumococcal bacteremia identified
by our microbiology laboratory from January 1, 1992, through December 31,
1996. Demographic, clinical, and laboratory data were abstracted.
Results There were 462 bacteremic episodes in 432 patients; 23 of these patients
had 30 recurrent episodes. The 5.3% recurrence rate (23/432) is greater than
that previously described. The median time to recurrence was 200 days. The
mean age of patients with recurrences was 34 years, 70% were women, all were
black or Hispanic (in near equal numbers), and 87% were infected with the
human immunodeficiency virus (HIV). Human immunodeficiency virus infection,
coexistent cancer, and female sex were independent predictors of recurrence.
Only patients who were HIV-infected had multiple recurrences. Isolates from
recurrent bacteremias were more likely to be penicillin-resistant than were
initial bacteremic isolates (relative risk, 2.0; P
= .16). Patients with recurrences had a higher (although not statistically
significant) mortality rate than those without recurrences (22% vs 16%; P = .33). There was an inverse relationship between severity
of illness and likelihood of recurrence.
Conclusions Rates of recurrent pneumococcal bacteremia may be higher than previously
reported. In patients with recurrent pneumococcal bacteremia, the presence
of an underlying immunodeficiency should be investigated.
From the Section of Infectious Diseases, Department of Medicine, Saint
Vincents Hospital and Medical Center, New York (Dr Turett); and the Division
of Infectious Diseases, Department of Medicine, Bronx-Lebanon Hospital Center,
Albert Einstein College of Medicine, Bronx (Drs Blum and Telzak), NY.
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