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Bacteremic Pneumococcal Pneumonia in HIV-Seropositive and HIV-Seronegative Adults^*

^* From the Department of Medicine (Drs. Feldman, Morar, and Mahomed), Hillbrow Hospital, University of the Witwatersrand, Johannesburg; and the Wits/MRC Pneumococcal Diseases Research Unit (Drs. Glatthaar, Kaka, Klugman, and Ms. Cassel), University of the Witwatersrand, Johannesburg, South Africa.

Correspondence to: Charles Feldman PhD, FCCP, Department of Medicine, University of the Witwatersrand, Medical School, 7 York Road, Parktown, 2193, Johannesburg, South Africa; e-mail: 014charl{at}chiron.wits.ac.za

Study objectives: To compare the demographic, clinical, laboratory, and microbiological data, and the hospital course and outcome of HIV-seropositive and HIV-seronegative adults with bacteremic pneumococcal pneumonia.

Design: Retrospective observation study conducted over a 2-year period.

Setting: Academic teaching hospital attached to the University of the Witwatersrand, Johannesburg, South Africa.

Patients: Consecutive patients with bacteremic pneumococcal pneumonia were identified on the basis of positive blood culture results.

Interventions: All available demographic, clinical, routine laboratory, radiographic, and microbiological data were recorded retrospectively for each of the patients, and the combined data for the HIV-seropositive patients were compared with those of the HIV-seronegative patients.

Measurement and results: A total of 112 patients (31 HIV-seropositive and 81 HIV-seronegative patients) were entered into the study. The HIV-seropositive patients were significantly younger than the HIV-seronegative patients (32.8 vs 39.6 years old) and had lower admission hemoglobin (11.8 vs 13.4 g/dL), WBC count (10.3 vs 14.3 x 10⁹/L), serum albumin (31 vs 36 g/L), sodium (129 vs 132 mmol/L), and potassium (3.0 vs 3.5 mmol/L), respectively. Although the HIV-seropositive patients appeared to have more multilobar pulmonary consolidation on the chest radiograph than the HIV-seronegative patients (60% vs 34%), this did not quite reach statistical significance. In addition, the HIV-seropositive patients had significantly more infections (48.4% vs 20.8%) with pneumococcal serogroups/serotypes (serogroups 6, 19, 23, and serotype 14) that are found more commonly in children, and they also had more penicillin-resistant isolates (13% vs 2.5%) than the HIV-seronegative patients, respectively. Similarly, it was noted that when these data were analyzed according to gender (irrespective of HIV status), women had significantly more infections than men (47% vs 21%) with serogroups/serotypes that are usually found in children, more penicillin-resistant isolates (15% vs 1%), and more co-trimoxazole-resistant isolates (21% vs 5%), respectively. There were no differences noted in any of the other parameters, including initial APACHE (acute physiology and chronic health evaluation) II score, PaO₂/fraction of inspired oxygen ratio, duration of temperature, duration of IV therapy, duration of hospitalization, complications, and outcome, when comparing HIV-seropositive and HIV-seronegative patients. Two patients in each group died.

Conclusions: The clinical features of bacteremic pneumococcal pneumonia are similar in HIV-seropositive and HIV-seronegative patients. Although differences are noted in various laboratory and microbiological parameters, they do not appear to have an impact on outcome.

Key Words: bacteremia • HIV • outcome • penicillin-resistant isolates • serogroups/serotypes • Streptococcus pneumoniae

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