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Invasive pneumococcal (Streptococcus pneumoniae) infections and bacteremia

Daniel J Sexton, MD
Section Editor
John G Bartlett, MD
Deputy Editor
Anna R Thorner, MD


Invasive pneumococcal disease is defined as an infection confirmed by the isolation of Streptococcus pneumoniae from a normally sterile site (eg, blood or cerebrospinal fluid but not sputum). S. pneumoniae (the pneumococcus) is an important and well-known cause of bacteremia in both immunocompetent and immunosuppressed patients. Pneumococcal bacteremia can occur as a result of pneumococcal pneumonia or in its absence. When bacteremia is present, secondary complications, such as arthritis, meningitis, and/or endocarditis, may occur.

This topic review will focus on the epidemiology, clinical manifestations, diagnosis, and treatment of pneumococcal bacteremia and selected aspects of other forms of invasive pneumococcal infections, such as meningitis, endocarditis, peritonitis, and various focal infections. The clinical features, epidemiology, and treatment of pneumococcal pneumonia and meningitis as well as vaccination against S. pneumoniae and the microbiology and pathogenesis of S. pneumoniae are discussed separately. (See "Pneumococcal pneumonia in adults" and "Pneumococcal vaccination in adults" and "Microbiology and pathogenesis of Streptococcus pneumoniae".)


The incidence of invasive pneumococcal disease in any population is affected by geographic location, time of year, serotype prevalence, age, comorbidities, and vaccination status. The highest incidence of invasive pneumococcal disease occurs in adults ≥65 years of age, in children <2 years of age, and in those with certain underlying conditions, such as HIV infection. According to the United States Active Bacterial Core surveillance (ABCs) database of the Emerging Infections Program Network, in 2010 the incidence of invasive pneumococcal disease in individuals ≥65 years of age was 36.4 cases per 100,000 population and, in infants <1 year, the incidence was 34.2 cases per 100,000 population, compared with 3.8 cases per 100,000 population in individuals between 18 and 34 years of age (table 1) [1]. However, some subgroups have markedly higher risks. For example, in adults aged 18 to 64 years of age with a hematologic malignancy, the incidence was 186 per 100,000 population and, for individuals with HIV infection, the incidence was 173 per 100,000 population in 2010 [2].

Impact of childhood vaccination — The overall incidence of invasive pneumococcal disease in the United States declined following the introduction and widespread use of the 7-valent pneumococcal conjugate vaccine (PCV7) in children, beginning in 2000 [3-8]. This reduction was due to declines in the incidence of invasive pneumococcal disease in the vaccinated population (children) and in adults presumably due to indirect effects on pneumococcal transmission via herd immunity. However, simultaneous increases in the proportion of cases of pneumococcal infections and nasopharyngeal colonization due to pneumococcal serotypes not included in the PCV7 vaccine (so-called replacement strains) were observed [4-7].

Following the introduction of PCV7, reductions in pneumococcal meningitis and hospitalizations for all-cause pneumonia were observed in both children and adults [9,10]. In a population-based study in one county in Minnesota, reductions in case-fatality and mortality rates were also observed [11]. The largest reductions in case-fatality rates were observed in adults ≥65 years of age and in patients with invasive pneumonia.


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Literature review current through: Sep 2016. | This topic last updated: Mar 28, 2016.
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