Pneumococcal bacteraemia in adults in a low socio-economic urban population.

Between January 1984 and December 1985, 183 adult patients, subsequently shown to have pneumococcal bacteraemia, were admitted. Of these infections, nine were caused by penicillin-resistant strains, and three of these were resistant to other antibiotics. The organisms from 150 patients were serotyped/grouped. The primary site of infection was lung in 90 per cent of patients. Among the patients with pneumonia, those with serovar 3 strains accounted for most intensive care unit admissions, most cases requiring inotropic drugs, and mechanical ventilation and had the highest complication rate and mortality. Findings which predicted the need for intensive care included higher age, elevated concentrations of serum urea, creatinine, and phosphate and lower levels of total serum protein, albumin and calcium. Twenty-four patients died of whom 23 had pneumonia. The case fatality rate among all of the patients admitted to the intensive care unit was 60 per cent and among those not admitted to the unit, 9.2 per cent. Of the patients who died, 41.7 per cent did so within the first five days of admission. The prophylactic use of polyvalent pneumococcal vaccine in industrial workers from low socio-economic groups should be carefully considered.