Reduced Mortality of Pneumococcal Bacteremia after Early Intensive Care

Abstract

The mortality of pneumococcal bacteremia has been constant at 25 to 45% over the past 25 years, approximately the same mortality that was reported at our hospital in 1974 prior to the opening of the intensive care unit (ICU). In an effort to identify the effect of care in the ICU, we analyzed outcomes in 150 consecutive cases of adult patients with pneumococcal bacteremia over a 27-month period, devoting special attention to severity of illness and timing of transfer to the ICU. Ninety-six (64%) patients were cared for outside the ICU (mean APACHE II score, 11; range, 0-29) and 54 (36) were cared for in the ICU (mean APACHE II score, 20; range, 5-38). Of the patients cared for in the ICU, 48 (89%) were admitted there within two days of hospital admission. In the entire series, there were 28 deaths (overall mortality, 19%); 6 deaths occurred outside the ICU (ward mortality, 6%), and 22 deaths occurred in the ICU (ICU mortality, 41%). Only 3 deaths (11%) occurred during the first 24 hours of hospitalization, the interval that has been associated with the greatest risk of death in prior reports. These data support our recent experience that care in the ICU has improved outcome for selected cases of pneumococcal bacteremia, especially if patients are admitted to the ICU without delay.