Volume 22, Number 2—February 2016
Epidemiology of Serotype 1 Invasive Pneumococcal Disease, South Africa, 2003–2013
|No. deaths/no. cases (%)||OR (95% CI)||p value||aOR (95% CI)||p value|
|Age group, y|
|<1||102/355 (29)||11.49 (2.75–47.95)||<0.001||12.06 (1.45–100.26)||0.02|
|1||22/154 (14)||4.75 (1.08–20.88)||3.83 (0.41–35.35)|
|2||11/94 (12)||3.78 (0.81–17.69)||1.30 (0.12–14.34)|
|3||6/73 (8)||2.55 (0.49–13.14)||1.40 (0.12–15.82)|
|Western Cape||15/111 (14)||0.81 (0.44–1.50)|
|KwaZulu-Natal||26/111 (23)||1.58 (0.93–2.68)|
|Eastern Cape||12/44 (27)||1.94 (0.94–4.01)|
|Free State||11/62 (18)||1.11 (0.55–2.28)|
|Mpumalanga||7/19 (37)||3.02 (1.13–8.01)|
|North-West||11/23 (48)||4.74 (1.99–11.30)|
|Limpopo||7/21 (33)||2.58 (1.00–6.71)|
|Length of hospital stay, d|
|4–14||36/354 (10)||0.14 (0.09–0.21)||0.06 (0.03–0.15)|
|>15||10/160 (6)||0.08 (0.04–0.16)||0.02 (0.01–0.07)|
|Pitt bacteremia score†|
|>4||16/28 (58)||6.61 (3.04–14.40)|
|Underlying medical condition‡|
|Yes||33/158 (21)||1.38 (0.86–2.23)||3.21 (1.49–6.91)|
|Antimicrobial drug use in 24 h before admission|
|Yes||15/56 (26)||1.88 (1.00–3.56)|
|HIV-infected||52/263 (20)||1.43 (0.90–2.27)||2.82 (1.36–5.84)|
|Clinical syndrome/specimen type|
|Blood||83/530 (16)||0.34 (0.23–0.50)|
|Other||1/39 (3)||0.05 (0.01–0.36)|
|Pneumonia||50/410 (12)||0.25 (0.17–0.38)||0.25 (0.11–0.54)|
|Bacteremia||18/111 (16)||0.35 (0.20–0.63)||0.11 (0.03–0.42)|
*All patients were reported from the enhanced Group for Enteric, Respiratory, and Meningeal Disease Surveillance in South Africa (GERMS-SA) surveillance sites. Only variables significant on univariate and multivariable analysis are shown. Variables not included in table are sex, year, previous hospital admission, prematurity, antimicrobial drug in previous 2 mo, and penicillin nonsusceptible invasive pneumococcal disease. aOR, adjusted odds ratio; OR, odds ratio.
†Pitt bacteremia score calculated using temperature, hypotension, mechanical ventilation, cardiac arrest and mental status. Severe disease defined as score of >4 points.
‡Includes asplenia or sickle cell anemia; chronic illness (i.e., chronic lung, renal, liver, cardiac disease, and diabetes); other immunocompromising conditions (i.e., organ transplant, primary immunodeficiency, immunotherapy, and malignancy, but excluding HIV); and other risk factors (i.e., head injury with possible cerebral spinal fluid leak, neurologic disorders, burns, and chromosomal abnormalities). Excludes malnutrition.
§Children with weight-for-age z-score of less than −2 (World Health Organization child growth standards 2009) (18), nutritional edema, or both.
¶Clinical diagnoses were made on the basis of documented discharge diagnoses in patient medical records, with clinical syndrome separated into 3 groups: meningitis, bacteremic pneumonia, and bacteremia without focus or other diagnosis (e.g., septic arthritis, endopthalmitis, peritonitis, pericarditis)
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