Six of the eight patients died of septic shock and two died of respiratory failure. Of the six patients with septic shock (five of six intubated, one of six designated “do not resuscitate” and not intubated), five died in five days or less (average, 2.8 days). One patient in septic shock was hospitalized for 31 days for jaundice and developed a nosocomial pneumonia and subsequently died. The two patients with respiratory failure (1 and 7) had an average hospital stay of 31 days. Patient 1 had combined PCP and strep pneumonia, and the other patient had pneumonia complicated by a spontaneous pneumothorax and death.
Three of eight patients were smokers and two of eight patients were heavy drinkers. The two heavy drinkers did not smoke. Patient 9 did not smoke or drink and had no other risk factors. She did, however, sign out against medical advice after one day of intravenous antibiotic therapy; she came back to the hospital several days later and died in less than 24 h in shock. Risk factors for increased morbidity with pneumococcal pneumonia in this group (Table 1) in addition to AIDS included previous splenectomy in two patients, chronic obstructive pulmonary disease with age older than 55 years in one patient, complicated pneumonia with pneumothorax in patient 7, and liver dysfunction in patient 13 due to a hospital admission initially for jaundice. Patients 1, 9, and 14 were both nonsmokers and nondrinkers with AIDS as the only risk factor.