Table 2. Factors associated with death in patients <5 years of age with serotype 1 invasive pneumococcal disease, South Africa, 2003–2013*.

Variable	Univariate analysis				Multivariable analysis
	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)
4	2/59 (3)	Reference			Reference
Province
Gauteng	53/327 (16)	Reference	0.001
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)
Northern Cape	1/17 (6)	0.32 (0.04–2.49)
Medical condition/treatment
Length of hospital stay, d
<3	94/209 (45)	Reference	<0.001		Reference	<0.001
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†
0–3	102/608 (17)	Reference	<0.001
>4	16/28 (58)	6.61 (3.04–14.40)
Underlying medical condition‡
No	55/343 (16)	Reference	0.19		Reference	0.003
Yes	33/158 (21)	1.38 (0.86–2.23)			3.21 (1.49–6.91)
Antimicrobial drug use in 24 h before admission
No	82/504 (16)	Reference	0.05
Yes	15/56 (26)	1.88 (1.00–3.56)
HIV status
HIV-uninfected	37/252 (15)	Reference	0.13		Reference	0.005
HIV-infected	52/263 (20)	1.43 (0.90–2.27)			2.82 (1.36–5.84)
Malnourished§
No	44/277 (16)	Reference	0.03
Yes	43/176 (24)	1.71 (1.07–2.74)
Clinical syndrome/specimen type
Specimen type
CSF	59/166 (36)	Reference	<0.001
Blood	83/530 (16)	0.34 (0.23–0.50)
Other	1/39 (3)	0.05 (0.01–0.36)
Clinical syndrome¶
Meningitis	74/209 (35)	Reference	<0.001		Reference	0.0003
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)