Is adjunctive corticosteroid beneficial in pneumococcal meningitis in a region with high rates of resistance to penicillin and ceftriaxone?

Abstract

The role of adjunctive corticosteroids remains controversial in meningitis by penicillin-resistant pneumococci. We determined the effect of adjunctive corticosteroids in adults with pneumococcal meningitis in a region with a high rate of penicillin resistance. A multicenter, retrospective cohort study was conducted between 1998 and 2008 in Korea. The mortality and neurological sequelae were evaluated. Among 93 patients with pneumococcal meningitis, adequate adjunctive corticosteroids were given in 45.2%. The penicillin resistance rate was 60.0%, and 42.1% were nonsusceptible to ceftriaxone. The 30-day mortality rates in the group receiving adequate corticosteroid therapy, the group in which corticosteroid was not given, and that inadequately given were 24.3, 31.6, and 27.3%, respectively, and there was no difference between the groups. The rates of development of neurological sequelae were 34.3, 33.3, and 43.5%, respectively. Multivariate analysis showed that adequate corticosteroids did not reduce mortality (HR 0.773, 95% CI 0.293-2.040) and neurologic sequelae (HR 0.604, CI 0.262-1.393). Propensity-adjusted analysis showed that adjunctive corticosteroid was not associated with time to death (HR 0.949, CI 0.374-2.408), however, a decreasing tendency was shown in neurologic sequelae in the adequate corticosteroid group (HR 0.479, CI 0.207-1.110). In conclusion, adjunctive corticosteroids did not affect mortality in adults with pneumococcal meningitis in a region with high rates of resistance to penicillin and ceftriaxone; however, the patients receiving adequate corticosteroid therapy tended to develop neurologic sequelae less frequently.

CRH promotes S. pneumoniae growth in vitro and increases lung carriage in mice

“…The inability to tailor inflammatory responses hinders significant advances to improve disease outcomes associated with infectious pneumonia. Despite the current use of systemic corticosteroids as standard adjunctive treatment to reduce inflammatory reactions in cases of pneumonia ( Steel et al, 2013 ; Sibila et al, 2014 ), mortality and morbidity rates remain high ( Lin et al, 2010 ; Moon et al, 2012 ; Peterkovic et al, 2012 ), raising questions of their benefit ( Ramsey and Gorman, 2014 ; Sibila et al, 2014 ). Stress-induced release of endogenous glucocorticoids or other hormones may negatively impact adjunctive corticosteroid use.…”