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  • Title: Characteristics and outcomes of older adults with community-acquired pneumococcal bacteremia.
    Author: Chi RC, Jackson LA, Neuzil KM.
    Journal: J Am Geriatr Soc; 2006 Jan; 54(1):115-20. PubMed ID: 16420207.
    Abstract:
    OBJECTIVES: To describe baseline characteristics and clinical outcomes of older adults with pneumococcal bacteremia, compare the frequency of serious outcomes according to pneumococcal vaccination status, and assess factors associated with mortality. DESIGN: Population-based case-series. SETTING: Group Health Cooperative, a health maintenance organization in Washington State. PARTICIPANTS: Community-dwelling adults aged 65 and older with a first episode of pneumococcal bacteremia between 1988 and 2002. MEASUREMENTS: Demographic characteristics, underlying medical conditions, vaccination status, and clinical outcomes, including death, hospitalization, length of hospital stay, and postdischarge care, were assessed using chart review. RESULTS: The mean age of the 200 elderly patients with pneumococcal bacteremia was 78; 61% were female. Forty percent had had chart-documented pneumococcal vaccination before the onset of bacteremia. The spectrum of clinical severity and consequences was broad. Ten percent were treated as outpatients. Of the 90% who were hospitalized, 16% were admitted to the intensive care unit. All-cause mortality at 30 days was 11%. Of survivors, 23% were discharged with home services, and another 20% were discharged to a nursing home. After controlling for age, sex, and pneumococcal vaccination status, predictors of death included coronary artery disease (odds ratio (OR)=4.6, 95% confidence interval (CI)=1.4-14.5) and immunocompromising conditions (OR=5.0, 95% CI=1.6-15.7). Outcomes were similar in patients who did and did not receive pneumococcal vaccination. CONCLUSION: In this elderly group, pneumococcal bacteremia was associated with substantial morbidity, mortality, and loss of independence. Coronary artery disease and immunocompromising conditions were independent predictors of death.
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