Reviewed by Mary Fortini, DO, DTM, University of Utah
This is a 10-year retrospective review of Streptococcus pneumoniae bloodstream infections (BSIs) identified in a single 850 bed tertiary care center in Ireland. Between January 1, 2014 and December 31, 2023, a total of 176 S. pneumoniae BSIs were detected. The median age of detection was 69.5 years old and risk factors seen included chronic heart disease (29%, n=51), chronic kidney disease (26%, n=46), diabetes mellitus (16%, n=28), chronic pulmonary disease (11%, n=19), and chronic liver disease (4%, n=7). Only 31% (n=55) of cases were found to have had prior pneumococcal vaccination with the vaccine type being unknown. A respiratory source was the primary etiology of most of the BSIs (78%, n=138 cases), with CNS (3%, n=5) and abdominal etiologies (1%, n=2) following; the remainder etiologies were unknown. The most common complication was empyema (7%, n=13), followed by lung abscess (5%, n=8), and meningitis (3%, n=5); mortality was 6% (n=10). The majority of S. pneumoniae isolates were susceptible to penicillin (85%, n=149) and cefotaxime (98%, n=172); however, only 25% (n=37) of the penicillin-susceptible infections involved treatment de-escalation to a narrower beta-lactam, such as amoxicillin or penicillin. In 70% (n=114) of infections, serotypes contained in PCV20 contributed towards the BSI; 25% (n=41) of infections included serotypes contained in PCV 13 and 77% (n=126) of infections included serotypes contained in PPV23. Only 22% (n=38) of patients at discharge received recommendations regarding obtaining a pneumococcal vaccine, and out of these, only 26 patients were vaccinated upon follow-up. This study provided insight into the need for further education and collaboration with antimicrobial stewardship regarding recommendations for antibiotic optimization. Additionally, it highlighted the many vaccination opportunities in various healthcare settings that are being underutilized (i.e., hospital discharge, communication with primary care physicians).
Reference:
Ali S, Burns K, Dinesh B, et al. A decade of Streptococcus pneumoniae bloodstream infections: a single-center retrospective analysis. Antimicrobial Stewardship & Healthcare Epidemiology. 2026;6(1):e99. doi:10.1017/ash.2026.10369
