Penicillin-Resistant Pneumococcal Meningitis: Navigating a Therapeutic Minefield

Greene, G S; Demasi, R

doi:10.1097/00000441-199604000-00006

Cited by 3 publications

(2 citation statements)

References 55 publications

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“…pneumoniae strain shows sensitivity to cefotaxime). Combination therapy is highly recommended, as the bacterium may develop resistance to ceftriaxone monotherapy (Ball, 1999;Greene and Demasi, 1996;Tunkel and Scheld, 2003). Levofloxacin, a fluoroquinolone, is also highly effective against S. pneumoniae (Goldstein & Garabedian-Ruffalo, 2002;Tunkel & Scheld, 2003).…”

Section: Antibiotics In the Treatment Of Ipdmentioning

confidence: 99%

Periodicity of Epidemics of Invasive Disease due to Infection With Streptococcus pneumoniae in the United States

Eckrode

Morrell

et al. 2010

Annals of Epidemiology

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Despite the availability of vaccines, every year 40,000 individuals die due to the direct effect of Invasive Pneumococcal Disease (IPD) or its complications. IPD has been associated with 100,000-135,000 hospitalizations for pneumonia, 57,000 cases of bacteremia, and 300 cases of meningitis in the United States every year. Little is known about IPD epidemic patterns beyond annual seasonality, and this lack of understanding has limited the ability to detect early changes in IPD epidemiology that may lead to large outbreaks. To mitigate this gap in understanding, a retrospective cohort design study was conducted using a population-based cohort from the National Hospital Discharge Survey for the period 1979-2006. This study set out to determine whether invasive infection by S. pneumoniae in the United States occurs in an epidemic pattern of a predictable recurrent nature and definable frequency. The theoretical basis for the study was drawn from the dynamic modeling of stochastic epidemic systems, and the analysis utilized time-series methods to examine the data. These analyses lead to the finding that IPD epidemics demonstrate a chaotic dynamic and a discrete, non-Markov process; that is, there is no predictable pattern to epidemics of IPD. The results of this study, that recurrent events consistent with periodic epidemics could not be identified, provide support for the current method of IPD surveillance and existing models of IPD dynamics. The present practice of mass vaccination by risk group, as opposed to vaccination for a predicted outbreak, is supported by the results of this study. These evidence-supported interventions will yield significant reductions in the morbidity and mortality associated with IPD, and the positive social change that results from improved health outcomes, reductions in suffering, and decreased health care costs.

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Section: Antibiotics In the Treatment Of Ipdmentioning

confidence: 99%

Periodicity of Epidemics of Invasive Disease due to Infection With Streptococcus pneumoniae in the United States

Eckrode

Morrell

et al. 2010

Annals of Epidemiology

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“…Among patients with central nervous system infections and otitis media caused by penicillinresistant pneumococci, clinical evidence appears to support a correlation between reduction in antimicrobial susceptibility and increased rates of treatment failure. [17][18][19][20][21][22][23][24][25][26][27][28][29] In contrast, similar data supporting this correlation between in vitro resistance and clinical outcome for patients with pneumococcal bacteremia or pneumonia are virtually nonexistent. In fact, several groups conducted extensive searches of the literature during the process of developing treatment recommendations and found little to no evidence to suggest that such a relationship exists in patients with pneumococcal bacteremia or pneumonia, at least with S. pneumoniae isolates with MICs up to 1-2 µg/ml.…”

Section: (Pharmacotherapy 2003;23(3):349-359)mentioning

confidence: 99%

Health Care Resource Utilization Associated with Treatment of Penicillin‐Susceptible and ‐Nonsusceptible Isolates of Streptococcus pneumoniae

Klepser

Ernst

et al. 2003

Pharmacotherapy

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Despite failure to correlate in vitro susceptibility with clinical outcomes for respiratory tract infections and bacteremia, resistance affects management of patients with pneumococcal infections. The economic impact of resistance among pneumococci has not been evaluated. We conducted a single-center, retrospective, observational, cohort study of hospitalized patients infected with Streptococcus pneumoniae isolated from blood or a respiratory source between January 1, 1995, and December 31, 1998. Data were collected for 36 days surrounding the day that the first positive culture was collected. Patients were grouped according to isolate penicillin-susceptibility profile [susceptible minimum inhibitory concentration (MIC) < or = 0.06 microg/ml, nonsusceptible MIC > or = 0.125 microg/ml), and data were analyzed with respect to health care resource utilization patterns. Of 231 patients identified, 142 and 89 had susceptible and nonsusceptible isolates, respectively. Groups were similar with respect to demographics and comorbidities, except that patients infected with a nonsusceptible isolate were more likely to have the isolate obtained from a respiratory source and to have a history of recent antibiotic therapy. No difference was noted with respect to clinical outcome; however, patients infected with a nonsusceptible isolate had a longer median stay (14 vs 10 days, p<0.05). They also had significantly higher total median costs (1600 dollars, 95% confidence interval 257-2943 dollars) due to room and nursing services. Infections caused by penicillin-nonsusceptible pneumococci were not associated with a worse outcome in hospitalized patients but were associated with increased cost of care.

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Prophylaxe gegen Infektionen durch Streptococcus pneumoniae

Randerath

König

Saalmann³

et al. 2000

Med Klin

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Streptococcus pneumoniae is the most common etiologic agent in outpatients pneumonia. Pneumococcal infections are often associated with high mortality risk in immunocompromised patients. An increasing resistance of Streptococcus pneumoniae to antibiotics is observed worldwide. This led to the official recommendation by the STIKO to use the vaccination in special risk groups. The commercially available 23-valent polysaccharide vaccine produces a reliable immune response against pneumococcal infection in children aged over 2 years and adults. The recommendation should be more realized in practice.

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Penicillin-Resistant Pneumococcal Meningitis: Navigating a Therapeutic Minefield

Cited by 3 publications

References 55 publications

Periodicity of Epidemics of Invasive Disease due to Infection With Streptococcus pneumoniae in the United States

Periodicity of Epidemics of Invasive Disease due to Infection With Streptococcus pneumoniae in the United States

Health Care Resource Utilization Associated with Treatment of Penicillin‐Susceptible and ‐Nonsusceptible Isolates of Streptococcus pneumoniae

Prophylaxe gegen Infektionen durch Streptococcus pneumoniae

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