Research Article| Volume 47, ISSUE 1, P12-18, July 2003

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Pneumococcal bacteraemia: clinical and microbiological epidemiology in Dundee, Scotland


      Objective: To report the incidence of drug resistant Streptococcus pneumoniae isolated from blood culture in Dundee, Scotland. We shall also review the clinical and laboratory findings in these cases.
      Methods: A retrospective review was undertaken of all cases of S. pneumoniae bacteraemia identified in our local area during a three year period from August 1st, 1997 to July 31st, 2000 (107 cases.) Data was obtained from patient medical records, blood culture reports and results of Stoke's disk testing. Many organisms were also sent to the Scottish Meningococcus and Pneumococcus Reference Laboratory for serogrouping and determination of the minimum inhibitory concentration of common antibiotics.
      Results: Annual incidence of bacteraemia was approximately 15.9–17.8 per 100 000 population. Mortality was 33% (34 and 30% for those with pneumonia or meningitis, respectively). No relationship was seen between patient age and overall mortality. Factors relating to increased mortality were a high respiratory rate (p=0.01), high blood urea level (p=0.05) and the presence of confusion (p<0.01) on admission to hospital.
      The incidence of penicillin resistant S. pneumoniae was 7%, all of these isolates having low level resistance. Macrolide resistance was 8%. Neither were found to be increasing over the three year period. The most common serogroups were 23 (18%) and 14 (12%).
      Conclusions: The incidence of penicillin resistant S. pneumoniae isolated from blood culture in Dundee, Scotland, is similar to the UK average and did not appear to be rising between 1997 and 2000.


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        • Meyer R.D.
        • Finch R.G.
        Community acquired pneumonia.
        J Hosp Infect. 1992; 22: 51-59
        • Taylor S.N.
        • Sanders C.V.
        Unusual manifestations of pneumococcal infection.
        Am J Med. 1999; 107: 12-27
        • Singh K.P.
        • Voolmann T.
        • Land S.D.
        Pneumococcal bacteraemia in South Aukland: a five year review with emphasis on prescribing practices.
        NZ Med J. 1992; 105: 394-395
        • Plouffe J.F.
        • Moore S.K.
        • Davis R.
        • Facklam R.R.
        Serotypes of Streptococcus pneumoniae blood culture isolates from adults in Fanklin County, Ohio.
        J Clin Microbiol. 1994; 32: 1606-1607
        • Kramer M.R.
        • Rudenski B.
        • Hadas-Halperin I.
        • Isacsohon M.
        • Melzer E.
        Pneumococcal bacteraemia—no change in mortality in 30 years: analysis of 104 cases and review of literature.
        Isr J Med Sci. 1987; 23: 174-179
        • Hansman D.
        • Glasgow H.
        • Surt J.
        • Devitt H.L.
        • Douglas R.
        Increased resistance to penicillin in pneumococci isolated from man.
        N Engl J Med. 1971; 284: 175-177
        • Markiewicz Z.
        • Tomasz A.
        Variations in penicillin binding proteins patterns of penicillin-resistant clinical isolates of pneumococci.
        J Clin Microbiol. 1989; 27: 405-410
        • Howes V.J.
        • Mitchell R.G.
        Meningitis due to a relatively penicillin-resistant pneumococcus.
        BMJ. 1976; 1: 996
        • Spencer R.C.
        • Wheat P.F.
        • Magee J.T.
        • Brown E.H.
        A three year survey of clinical isolates in the United Kingdom and their antimicrobial susceptibility.
        J Antimicrob Chemother. 1990; 26: 435-446
        • Andrews J.
        • Ashby J.
        • Jevons G.
        • Lines N.
        • Wise R.
        Antimicrobial resistance in gram positive pathogens isolated in the UK between October 1996 and January 1997.
        J Antimicrob Chemother. 1999; 43: 689-698
        • Wilson P.
        • Jenks P.
        • Hoque S.
        Prevalence of antibiotic resistance in pneumococci: prevalence of resistance to penicillin is higher in East London.
        BMJ. 1996; 313: 819-820
        • Allen K.D.
        • Anson J.J.
        Prevalence of antibiotic resistance in pneumococci: prevalence of resistance to penicillin is higher in Merseyside.
        BMJ. 1996; 313: 820
        • Goldsmith C.E.
        • Moore J.E.
        • Murphy P.G.
        Prevalence of antibiotic resistance in pneumococci: prevalence of resistance to penicillin is higher in Northern Ireland.
        BMJ. 1996; 313: 820
        • McKenzie H.
        • Reid N.
        • Dijkhuizen R.S.
        Clinical and microbiological epidemiology of Streptococcus pneumoniae bacteraemia.
        J Med Microbiol. 2000; 49: 361-366
        • British Thoracic Society
        Community-acquired pneumonia in adults in British hospitals in 1982–3: a survey of aetiology, mortality, prognostic factors and outcome.
        Quart J Med. 1987; 239: 195-220
        • Flemingham D.
        • Gruneberg R.N.
        The Alexander Project 1996–97: latest susceptibility data from this international study of bacterial pathogens from community-acquired lower respiratory tract infections.
        J Antimicrob Chemother. 2000; 45: 191-203
        • Heiber J.P.
        • Nelson J.D.
        A pharmacological evaluation of penicillin in children with purulent meningitis.
        N Engl J Med. 1977; 297: 410-413
        • Tweardy D.J.
        • Jacobs M.R.
        • Speck W.T.
        Susceptibility of penicillin-resistant pneumococci to eighteen antimicrobials: implications for treatment of meningitis.
        J Antimicrob Chemother. 1983; 12: 133-139
        • Metlay J.P.
        • Hopmann J.
        • Cetron M.S.
        • Fine M.J.
        • Farley M.M.
        • Whitney C.
        • Breiman R.F.
        Impact of penicillin susceptibility on medical outcomes for adult patients with bacteremic pneumococcal pneumonia.
        Clin Infect Dis. 2000; 30: 520-528
        • Örtqvist Å.
        • Kalin M.
        • Julander I.
        • Mufson M.
        Deaths in bacteremic pneumococcal pneumonia. A comparison of two populations—Huntington WVA, and Stockholm, Sweden.
        Chest. 1993; 103: 710-716
        • British Thoracic Society Guidelines for the Management of Community Acquired Pneumonia in Adults
        Thorax. 2001; 56
        • Breiman R.
        • Spika J.
        • Navarro V.
        • Darden P.
        • Darby C.
        Pneumococcal bacteraemia in Charleston County, Southern California, a decade later.
        Arch Intern Med. 1990; 150: 1401-1405
        • Broome C.
        • Facklam R.
        • Allen J.
        • Fraser D.
        • Austrian R.
        From the Center of Disease Control: epidemiology of pneumococcal serotypes in the United States, 1978–1979.
        J Infect Dis. 1980; 141: 119-123
        • Austrian R.
        • Gold J.
        Pneumococcal bacteraemia with especial reference to bacteremic pneumococcal pneumonia.
        Ann Intern Med. 1964; 60: 759-776
        • Hook III, E.
        • Horton A.
        • Schalberg D.
        Failure of intensive care unit support to influence mortality from pneumococcal bacteremia.
        JAMA. 1983; 249: 1055-1057
        • Jansson E.
        A 10-year study of bacteremia.
        Scand J Infect Dis. 1971; 3: 151-155
        • Mufson M.A.
        • Kruss D.M.
        • Wasil R.E.
        • Metzger W.I.
        Capsular types and outcome of bacteremic pneumococcal disease in the antibiotic era.
        Arch Intern Med. 1974; 134: 505-510
        • Beytout J.
        • Bernard E.
        • Stahl J.
        • Blanc D.
        • Beuscart C.
        Fatal septicemias: factors of mortality. Analysis of 72 fatal cases in the series of 462 case reports collected by the Septicemia Expert System group in 1985.
        Pathol Biol. 1987; 35: 819-824
        • Bruyn G.
        • Kremer H.
        • Marie S.
        • Padberg G.
        • Hermans J.
        • van Furth R.
        Clinical evaluation of pneumococcal meningitis in adults over a twelve-year period.
        Eur J Clin Microbiol Infect Dis. 1989; 8: 694-700
        • Kuikka A.
        • Syrjänan J.
        • Renkonen O.-V.
        • Valtonen V.V.
        Pneumococcal bacteremia during a recent decode.
        J Infect. 1991; 24: 157-168
        • Örtqvist Å.
        • Grepe A.
        • Julander I.
        • Kalin M.
        Bacteremic pneumococcal pneumonia in Sweden. Clinical course and outcome and comparison with non-bacteremic pneumococcal and mycoplasmal pneumonias.
        Scand J infect Dis. 1988; 20: 163-171
        • Laurichesse H.
        • Grimaud O.
        • Waight P.
        • Johnson A.P.
        • George R.C.
        • Miller E.
        Pneumococcal bacteraemia and meningitis in England and Wales, 1993 to 1995.
        Commun Dis Public Health. 1998; 1: 22-27
        • Department of Health, Welsh Office, Scottish Home and Health Department, Department of Health and Social Services Northern Ireland
        Immunisation against Infectious Disease. HMSO, London1992