PP 11 - Clinical and epidemiological profile of Streptococcus pneumoniae bacteraemia in a tertiary care hospital, Southern Sri Lankathern Sri Lanka

Piyasiri DLB, Jayasekera PK, Withanaarachchi K, Liyanaarachchi N, Mahesh WK, Jayathilleke W, Dias KMGHH, Silva SCUM , National Hospital, Galle

Abstract

Introduction

Streptococcus pneumoniae causes both invasive (IPD) and non-invasive diseases, which continue to pose a significant burden to the community. Positive blood cultures are associated with disease severity and may occur in 40% of IPD.

Objectives

This study aimed to describe the epidemiology, clinical profile, and antimicrobial susceptibility of pneumococcal bacteraemia.

Design, setting, and methods

A retrospective analysis of an anonymized database consisting of laboratory and clinical details of pneumococcal bacteraemia from January 2015 to March 2026 was conducted at a major tertiary care hospital. Penicillin susceptibility was primarily determined using oxacillin testing, and cefotaxime resistance was assessed by MIC e-strips.

Results

A total of 146 cases were identified, with the highest case detection in 2018 and 2025 (20 each). Most cases occurred in the first half of the year. Males predominated (101, 69%), and extremes of age were most affected: children <5 years (55, 38%) and adults >60 years (48, 33%).

Pneumonia was the most common presentation (74, 51%), followed by meningitis (42, 29%), neonatal sepsis (5, 3%), and endocarditis (4, 3%), with others (14%). Pneumonia was the main underlying cause for bacteraemia except in 2018, in which meningitis became the predominant cause(10/20). Neonatal bacteraemia was linked to maternal carriage, confirmed by identical vaginal cultures. One case of Austrian syndrome was diagnosed. Comorbidities were present in 64 patients (44%), including diabetes (19, 13%), chronic heart or lung disease (17, 12%), malignancy (8), cirrhosis (5), prematurity (3), HIV (1), and others (11). Oxacillin discs were available for testing of 134 isolates, and 71% were resistant. Cefotaxime resistance (MIC >1) was seen in 2%. Overall mortality was 20% (29/146), mainly among elderly patients (16/146, 11%) and children <5 years (5/146, 3%).

Conclusions

Pneumococcal bacteraemia was frequent in males and at the extremes of age, with the highest mortality among the elderly. Penicillin resistance was high (71%), with emerging cefotaxime resistance. Most cases occurred in the first half of the year, peaking in 2018 and 2025. These findings highlight the ongoing burden of IPD and the need for stewardship and preventive strategies.