Clinical implication of extended-spectrum cephalosporin nonsusceptibility in Streptococcus pneumoniae meningitis

Abstract

The clinical implication of extended-spectrum cephalosporin (ESC) resistance has been unclear in patients with Streptococcus pneumoniae meningitis (SPM). We collected the clinical data of 120 patients with SPM in 12 hospitals of the Republic of Korea. The clinical characteristics and outcomes of 23 ESC-nonsusceptible SPM episodes were compared to those of 97 ESC-susceptible episodes. Hospital acquisition, presence of other foci of pneumococcal infection, septic shock at initial presentation, or concomitant bacteremia were more commonly observed in ESC-nonsusceptible than ESC-susceptible SPM. Empiric antimicrobial therapy with vancomycin and ESC combination was very common in both groups. Although there was a tendency towards higher early fatality in ESC-nonsusceptible SPM (3-day mortality; 17.4 % vs. 4.4 %, p = 0.05), in-hospital mortality (26.1 % vs. 20.9 %, p = 0.59) and median length of hospital stay (20 days vs. 24 days, p = 0.34) did not differ between ESC-nonsusceptible and ESC-susceptible SPM.

Mortality indicators in pneumococcal meningitis: therapeutic implications

“…For example, in a Korean study, in-hospital mortality did not differ significantly in pneumococcal meningitis when the infecting agents were either resistant or susceptible to cefotaxime/ ceftriaxone. 26 The probable reasons for the inadequacy of vancomycin as part of the combination regimen may be due to its low CSF penetration and pneumococcal vancomycin tolerance. The use of steroids is known to further contribute to reduced vancomycin penetration into the CSF.…”

Global Case Fatality of Bacterial Meningitis During an 80-Year Period

“…We found additional studies specifically reporting on S pneumoniae (113 studies; 24 553 episodes) (eTable 8 in Supplement 1), N meningitidis (75 studies; 100 278 episodes) (eTable 9 in Supplement 1), H influenzae (49 studies; 28 796 episodes) (eTable 10 in Supplement 1), L monocytogenes (15 studies; 985 episodes) (eTable 11 in Supplement 1),…”

Mala respuesta a ceftriaxona en adultos con meningitis por Streptococcus pneumoniae

“…No se ha demostrado mayor mortalidad en pacientes con MBA por S. pneumoniae resistente versus los que cursan cuadros causados por cepas sensibles, ni tampoco un incremento en la estadía hospitalaria, posiblemente porque los estudios han sido realizados en escenarios donde la vancomicina ya es parte del esquema empírico. Sí se ha reportado mayor frecuencia de resistencia a Cef-3g en MBA de adquisición intrahospitalaria, cuando coexisten focos extrameníngeos y en cuadros de shock séptico como forma de presentación 9 . En adultos chilenos no hay por ahora datos que apoyen la inclusión de vancomicina en el esquema empírico de tratamiento de la MBA; sin embargo, hay que mantenerse alerta, conocer siempre el estudio de sensibilidad y repetir la punción lumbar con nuevo cultivo ante un paciente que después de 72 h de tratamiento con 4 g de ceftriaxona al día presente deterioro clínico progresivo, es decir, mayor compromiso de conciencia, persistencia de la fiebre, parámetros sépticos de laboratorio que no bajan, hipotensión arterial, focalidad, convulsiones, etc.…”