Serotyping of 1,458 pneumococcal isolates with analysis of bacteremia in 84 patients.

During a 61-month period, 1,458 pneumococcal isolates (including 87 bacteremia strains) were collected at the Albany Veterans Administration Medical Center and serotyped with the use of the typing system of the New York Department of Health Laboratories. Fifty percent of all isolates were of types in the 14-valent vaccine, while 68% were in 23-valent vaccine. Types 3, 6, 9, and 34 were the most prevalent types. Sixty-two percent of blood isolates were of types in the 14-valent vaccine, while 77% were in the 23-valent vaccine. Fifty-six percent of bacteremias were nosocomial and 44% were community acquired with a fatality rate of 41% and 18%, respectively. The fatality rate was greatest with risk factors such as asplenia and azotemia. These data support the recommendation for the use of 23-valent pneumococcal polysaccharide vaccine in high-risk patients, especially those who might acquire bacteremia in a nosocomial setting.