Patient selection: invasive infection with Streptococcus pneumoniae
Invasive pneumococcal disease: isolation of Streptococcus pneumoniae from a normally sterile site (blood, CSF, pleural effusion, joint effusion, peritoneal fluid, tissue biopsy).
Mortality rate: 18%, with 54% of non-survivors less than 2 years of age
All of the patients who died had sepsis with meningitis
Early findings seen more often in non-survivors:
(1) recurrent hyperpyrexia (temperature > 40°C)
(2) vomiting (> 3 times per day)
(3) anorexia
(4) lethargy
(5) poor perfusion of the extremities
(6) high PRISM III score (maximum score 74)
Factors affecting course:
(1) pneumococcal vaccine status, and coverage of vaccine versus the isolate
(2) antibiotic resistance shown by the isolate versus antibiotic coverage
