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[Retrospective and comparative study of pneumococcal bacteremia in patients with chronic hepatopathy].

BACKGROUND
The chronic hepatopathy predispose to severe infections due to Streptococcus pneumoniae, including bacteremia.


METHODS
We have reviewed the clinic characteristics and outcome of 34 patients without HIV infection and compared with 140 HIV-negative patients with pneumococcal bacteremia.


RESULTS
From 34 patients with chronic liver diseases, 27 were male (79%) and 7 female (21%), aged from 33 to 83 years. In 16 cases the origin of hepatopathy were alcoholic. The majority of the patients had fever (85%). From 29 isolations of S. pneumoniae in which a sensibility study was available, 5 (17%) were resistant to penicillin. Among 27 (79%) cases of chronic hepatopathy, the bacteremia was associated with pneumonia; 5 (18%) cases had roentgenographic evidence of multiple-lobe involvement, and 6 (18%) had peritonitis. The independent factors associated with pneumococcal bacteremia in chronic hepatopathy patients were elevated concentrations of amino-transferases (p < 0.001), alcoholism (p < 0.001) and bacteremic peritonitis (p = 0.007). The overall case of fatality and bacteremia-related mortality rate were higher among patients with chronic hepatopathy than control group, without statistic signification (38% vs 25%; and 29% vs 24% of control group, respectively). The presence of septic shock was poor prognosis (mortality rate: 83% [10/12]; p < 0.001). The multilobar involvement was associated with high mortality rate (60%; p = 0.1).


CONCLUSIONS
Pneumococcal bactermia in patients with chronic hepatopathy have a high mortality rate; however clinical outcome is similar to patients without chronic hepatopathy.