Pneumococcal bacteraemia in south Auckland: a five year review with emphasis on prescribing practices.

AIMS: to determine incidence, predisposing factors, management and outcome of pneumococcal bacteraemia in south Auckland.

METHODS

medical records were reviewed retrospectively of patients identified as having pneumococcal bacteraemia at Middlemore Hospital during five years 1986-90.

RESULTS

records were available for 143 of 149 episodes. The incidence of pneumococcal bacteraemia was 12.1/10,000 admissions. The male to female ratio was 1.2:1, 61.5% were over the age of 50 years, 76% had underlying medical conditions, and the mortality was 16.1%. Twenty of the 23 who died were over the age of 60 years. Just over half attended hospital within 48 hours of becoming unwell, while 10.5% had had symptoms for more than one week. Pneumonia was seen in 85% and meningitis in 7%. Initial treatment was with a single antibiotic in 94%. Following microbiological diagnosis, 54% were treated with penicillin G, but in over one-third, an unnecessarily broad spectrum antibiotic was continued as definitive treatment.

CONCLUSIONS

the incidence, age distribution, predisposing factors and mortality of pneumococcal bacteraemia in south Auckland is similar to those reported elsewhere. Inappropriately broad spectrum antibiotics are used too often in definitive treatment.