1092. Clinical characteristics of primary pneumococcal bacteremia in adult patients in the Republic of Korea
Session: Poster Abstract Session: Clinical Infectious Diseases: Bacteremia and Endocarditis
Friday, October 28, 2016
Room: Poster Hall
Background: There is limited information regarding primary pneumococcal bacteremia in adult patients. We conducted a study to investigate the clinical characteristics of primary pneumococcal bacteremia (PB) in adult patients in the Republic of Korea (ROK) from a prospective observational cohort.

Methods: Clinical data and pneumococcal isolates from adult patients diagnosed with invasive pneumococcal disease (IPD) were prospectively collected from 20 participating hospitals in ROK from March 2013 to December 2015 through the surveillance program for the comparison analysis between PB and pneumococcal bacteremic pneumonia (BP).

Results: There was a total of 319 cases of IPDs during the study period. The mean age was 67 and there were 221 male patients. BP and PB cases were noted in 205 and 43 cases, respectively. There were significantly more underlying immunosuppressed state (46.5% vs. 25.9%, P = 0.007) and higher clindamycin resistance (71.4% vs. 52.3%, P = 0.024) in PB cases than in BP cases. However, PB cases were noted for less underlying chronic nervous diseases (2.3% vs. 13.7%, P = 0.035), a lower Pitt bacteremic score (1.0 ± 2.0 vs. 3.2 ± 3.6, P < 0.001), and a lower case fatality rate (16.3% vs. 44.4%, P = 0.001) in comparison with BP cases. Multiple logistic regression analysis showed that clindamycin resistance (odd ratio [OR] 2.566, 95% confidence interval (CI) 1.191 – 5.529, P = 0.016) and survival of IPD (OR 3.182, 95% CI 1.164 – 8.698, P = 0.024) were significantly associated with PB. Rate of pneumococcal vaccination prior to IPD was low both in PB (11.6%) and BP (16.6%) cases. A total of 147 pneumococcal serotype isolates data was available for 29 cases of PB and 118 cases of BP. Non-conventional vaccine serotypes (7/29, 24.1%) and serotype 3 (4/29, 13.8%) were common in PB cases whereas serotype 3 (19/118, 16.1%) and serotype 22F (11/118, 9.3%) were common in BP cases. Prevalence of serotypes included in pneumococcal vaccination was lower in PB cases than in BP cases (48.3% vs. 72.9%).

Conclusion: Among adult patients in ROK, survival of IPD and increased clindamycin resistance were associated with PB cases. High case fatality rate and worse disease severity were noted for BP cases. Pneumococcal vaccination should be considered to prevent IPDs.

Jong Hun Kim, MD, Division of Infectious Diseases, Korea University College of Medicine, Seoul, Korea, The Republic of, Seung Hee Baik, MD, Korea University College of Medicine, Seoul, Korea, The Republic of, Joon Young Song, MD, Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea, Won Suk Choi, M.D., Korea University Ansan Hospital, Ansan, South Korea, Sae Yoon Kee, MD, Keonkuk University Hospital, Chungju, Korea, The Republic of, Younghee Jung, MD, Keonyang University Hospital, Daejeon, Korea, The Republic of, In Kyu Bae, MD, Kyeongsang University Hospital, Jinju, Korea, The Republic of, Hyun Hee Kwon, MD, Ph.D, Daegu Catholic University Medical Center, Daegu, Korea, The Republic of, Jeong Yeon Kim, M.D., Ph.D., Sahmyook Medical Center, Seoul, South Korea, Young Hwa Choi, MD, Ajou University College of Medicine, Suwon, South Korea, Young Keun Kim, MD, Yonsei University, Wonju, South Korea, Ji an Hur, MD, Youngnam University Hospital, Daegu, Korea, The Republic of, Ki-Eun Hwang, MD, Wonkwang University School of Medicine, Iksan, Korea, The Republic of, Yu-Mi Lee, MD, Department of Infectious Diseases, Busan Paik Hospital, Busan, South Korea, Ji Hyun Yoon, MD, Eulji University Hospital, Daejeon, Korea, The Republic of, Dong-Min Kim, M.D., PhD., Chosun University, Gwangju, Korea, The Republic of, Yoon Jung Oh, MD, Jeju Halla Hospital, Jeju, Korea, The Republic of, Jin-Won Chung, MD, Department of Internal Medicine, Chung-Ang University Medical Center, Seoul, South Korea, Yeon-Sook Kim, MD, Chungnam National University Hospital, Daejeon, Korea, The Republic of, Hye Won Jeong, M.D. Ph.D., Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, South Korea, Jacob Lee, M.D., Department of Internal Medicine, Hallym University Medical Center, Seoul, Korea, The Republic of, Byung Chul Chun, M.D., Ph.D., Preventive Medicine, Korea Univ. Coll. of Med., Seoul, South Korea and Min-Ja Kim, MD, Korea University Medical Center, Seoul, South Korea

Disclosures:

J. H. Kim, None

S. H. Baik, None

J. Y. Song, None

W. S. Choi, None

S. Y. Kee, None

Y. Jung, None

I. K. Bae, None

H. H. Kwon, None

J. Y. Kim, None

Y. H. Choi, None

Y. K. Kim, None

J. A. Hur, None

K. E. Hwang, None

Y. M. Lee, None

J. H. Yoon, None

D. M. Kim, None

Y. J. Oh, None

J. W. Chung, None

Y. S. Kim, None

H. W. Jeong, None

J. Lee, None

B. C. Chun, None

M. J. Kim, None

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