Nationwide study of recurrent invasive pneumococcal infections in a population with a low prevalence of human immunodeficiency virus infection

H. M. Einarsdöttir, H. Erlendsdóttir, K. G. Kristinsson, M. Gottfredsson*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

21 Citations (Scopus)


Recurrent invasive infections caused by Streptococcus pneumoniae are rare, and often considered to be indicative of serious underlying illness. However, the prevalence of this problem, and the relevance of specific predisposing conditions, can be hard to assess, since many of the studies are based on specific risk groups. A population-based study of recurrent invasive pneumococcal disease in Iceland during the 30-year period 1975-2004 was performed. Clinical information, including mortality and vaccine use, was analysed retrospectively. Invasive pneumococcal isolates were serotyped and susceptibility testing was performed. During this period, 36 (4.4%) of 819 patients who survived an initial infection experienced recurrence, with a median time between episodes of 9.7 months. Pneumonia with bacteraemia was the most common clinical diagnosis (48% of cases), followed by bacteraemia without a clear focus (21%) and meningitis (13%). Most (94%) of the patients had identifiable predisposing conditions, most commonly, multiple myeloma in adults, and antibody deficiencies in children. Compared with children, adults were more likely to present with pneumonia (65% vs. 18%; p 0.0001). No significant change in the 30-day mortality rate was observed during the three decades of the study. Only 26% of eligible patients received pneumococcal vaccination. Patients with recurrent invasive pneumococcal disease should be investigated thoroughly for underlying diseases. Greater use of pneumococcal vaccines should be encouraged among high-risk patients. More effective preventive and therapeutic measures are needed to improve outcome.

Original languageEnglish
Pages (from-to)744-749
Number of pages6
JournalClinical Microbiology and Infection
Issue number9
Publication statusPublished - Sept 2005

Bibliographical note

Funding Information:
This work was supported in part by a grant from Landspítali University Hospital Research Fund. The preliminary findings of this study were presented in part at the 39th Annual Meeting of the Infectious Diseases Society of America, San Francisco, CA, USA, October 2001 (abstract 79).

Other keywords

  • Bacteraemia
  • Invasive infections
  • Meningitis
  • Pneumococci
  • Recurrent infections
  • Streptococcus pneumoniae


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