Pneumococcosuria in adults

Abstract

Pneumococcal bacteriuria is usually felt to indicate systemic pneumococcal infection, especially in children. To determine the frequency and significance of pneumococcosuria in adults, we reviewed the Shreveport Veterans Administration Medical Center microbiology laboratory log books for 1982 through 1985. During these 4 years, more patients had pneumococcal bacteriuria than bacteremia (38 versus 33), but only 2 patients had both. The medical records from 31 bacteriuric patients with 35 positive urine specimens were available for review. The collection technique was reliable for 23 (66%) urine specimens; the type of collection technique used was unknown for 12 (34%). The urine pH was less than or equal to 6 in 24 (68%) specimens, and the specific gravity was greater than 1.020 in 12 specimens (34%). A total of 24 specimens grew only Streptococcus pneumoniae, and 11 yielded mixed growth. All 31 patients were men, 25 (81%) were 60 years or older, and 13 (42%) had underlying genitourinary disorders. A total of 7 patients had genitourinary symptoms, 7 had fever, 5 had leukocytosis, and 12 had pyuria; however, these symptoms and signs were frequently accounted for by factors other than pneumococcosuria. Pneumococcosuria was an unexpected finding in all but two (6%) bacteremic patients. These were the only patients with systemic pneumococcal infections, and both died despite appropriate antibiotics. Among the 20 surviving patients with follow-up urine samples, pneumococcosuria resolved whether or not they had received antibiotics. Thus, pneumococcosuria in our patient population was frequently not accompanied by systemic pneumococcal infection and by itself did not require antibiotic therapy.