Clinical Features And Outcomes Of Pneumococcal Bacteremia Among Children At A Tertiary Care Hospital

Background: Invasive pneumococcal disease (IPD) has high mortality among children. Pneumococcal bacteremia is an important marker of IPD but has received limited attention in predicting the outcomes of illness. The aim of this study was to evaluate clinical features, focus of infection, and comorbid of pneumococcal bacteremia in a pediatric cohort at a tertiary care center in Karachi, Pakistan. Methods: Children aged 0-14 years admitted to the Aga Khan University Hospital with pneumococcal bacteremia were identified through a laboratory database. Demographic, clinical, and outcome data were obtained from patients' medical records. Data entry and analysis were carried out in MS Excel and SPSS version 19.0. Results: Forty (n = 40) episodes of pneumococcal bacteremia in 39 children were identified. The median age of the cohort was 2.5 (interquartile range 4.15-1.1) years; 30% (n = 12) of these were infants aged 0-12 months. The primary focus of infection was identified as pneumonia in 47.5% (n = 19) and meningitis in 7.5% (n = 3). The prevalence of occult bacteremia was 27.5% (n = 11). Outcomes of infection at hospital discharge were assessed in 31 patients as nine patients were either transferred out or left against advice. Of 31 patients, 6 (19.4%) died and 25 (80.6%) were discharged home. Associations with mortality included sepsis (P = 0.017) and absence of a focus (occult bacteremia) (P = 0.007). Conclusion: Sepsis and occult bacteremia (without an underlying focus) were associated with mortality. No association was found between choice of antibiotics administered, penicillin minimum inhibitory concentration, and poor outcome at discharge. Other factors such as comorbidities, immune status, and focus of infection play an important role in predicting the outcomes of pneumococcal bacteremia.