Treatment of Drug-resistant Pneumococcal Meningitis

Hameed, Nida; Tunkel, Allan R.

doi:10.1007/s11908-010-0110-7

Cited by 15 publications

(10 citation statements)

References 54 publications

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“…107 Those previously vaccinated with PPSV23 should get a dose of PCV13 at least 1 year after the last PPSV23 dose. 119 Consultation with an infectious disease specialist is recommended for severe infections such as pneumonia, bacteremia, and meningitis. 116 Although it is safe to administer the vaccine while on immunosuppression, it is ideal to vaccinate patients before initiation of immunosuppression.…”

Section: Pneumococcal Infectionmentioning

confidence: 99%

Opportunistic Infections Due to Inflammatory Bowel Disease Therapy

Dave

Purohit

Razonable

et al. 2014

Inflammatory Bowel Diseases

114

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The use of biological agents and immunomodulators for inflammatory bowel disease (IBD) has remarkably improved disease management in the current era but at the same time has increased the risk of infectious complications. Patients with IBD on corticosteroids, immunomodulators, and biological agents are considered immunocompromised and are at risk for opportunistic infections. These are infections caused by organisms that take advantage of a weakened immune system, and cause disease, when they ordinarily would cause mild illness or no disease in an immunocompetent host. Risk factors for opportunistic infections include malnutrition, older age, congenital immunodeficiency, HIV infection, chronic diseases, and use of corticosteroids, immunomodulators, and anti-tumor necrosis factor alpha therapy. Apart from immunosuppressive medications and older age, there is only indirect evidence for above risk factors contributing directly to opportunistic infection risk in patients with IBD. Opportunistic infections in patients with IBD include viral infections (herpes viruses, human papillomavirus, influenza virus, and JC virus), bacterial infections (tuberculosis, nocardiosis, Clostridium difficile infection, pneumococcal infection, legionellosis, and listeriosis), fungal infections (histoplasmosis, cryptococcosis, Pneumocystis jirovecii infection, aspergillosis, and candidiasis), and parasite infections (Strongyloides stercoralis). Although these infections lead to high morbidity and mortality, only a minority of patients with IBD develop opportunistic infections. Currently, we lack a test to accurately predict patients at risk of opportunistic infection, and future research needs to focus on biomarkers or predictive models for risk stratification. Until such a test is developed, we need to screen, prevent, diagnose, and treat opportunistic infections in all patients with IBD in a timely manner.

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Section: Pneumococcal Infectionmentioning

confidence: 99%

Opportunistic Infections Due to Inflammatory Bowel Disease Therapy

Dave

Purohit

Razonable

et al. 2014

Inflammatory Bowel Diseases

114

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“…In addition, for S. pneumoniae , MICs to rifampin are extremely low [ 26 ]. Resistance remains exceptional [ 27 ]. Moreover, unlike vancomycin, its distribution is unaffected by the addition of corticosteroid therapy [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

Rifampin use in acute community-acquired meningitis in intensive care units: the French retrospective cohort ACAM-ICU study

et al. 2015

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IntroductionBacterial meningitis among critically ill adult patients remains associated with both high mortality and frequent, persistent disability. Vancomycin was added to treatment with a third-generation cephalosporin as recommended by French national guidelines. Because animal model studies had suggested interest in the use of rifampin for treatment of bacterial meningitis, and after the introduction of early corticosteroid therapy (in 2002), there was a trend toward increasing rifampin use for intensive care unit (ICU) patients. The aim of this article is to report on this practice.MethodsFive ICUs participated in the study. Baseline characteristics and treatment data were retrospectively collected from charts of patients admitted with a diagnosis of acute bacterial meningitis during a 5-year period (2004–2008). The ICU mortality was the main outcome measure; Glasgow Outcome Scale and 3-month mortality were also assessed.ResultsOne hundred fifty-seven patients were included. Streptococcus pneumoniae and Neisseria meningitidis were the most prevalent causative microorganisms. The ICU mortality rate was 15 %. High doses of a cephalosporin were the most prevalent initial antimicrobial treatment. The delay between admission and administration of the first antibiotic dose was correlated with ICU mortality. Rifampin was used with a cephalosporin for 32 patients (ranging from 8 % of the cohort for 2004 to 30 % in 2008). Administration of rifampin within the first 24 h of hospitalization could be associated with a lower ICU survival. Statistical association between such an early rifampin treatment and ICU mortality reached significance only for patients with pneumococcal meningitis (p=0.031) in univariate analysis, but not in the logistic model.ConclusionsWe report on the role of rifampin use for patients with community-acquired meningitis, and the results of this study suggest that this practice may be associated with lower mortality in the ICU. Nevertheless, the only independent predictors of ICU mortality were organ failure and pneumococcal infection. Further studies are required to confirm these results and to explain how rifampin use would reduce mortality.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-015-1021-7) contains supplementary material, which is available to authorized users.

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“…Besides, as you can see from the case discussed, an early and correct antibiotic therapy may not always avoid disseminations. The child, although immediately and continuously treated with a cephalosporin (ceftriaxone first and then cefotaxime), has probably had osteomyelitis as complication, requiring a double antibiotic therapy with a high diffusibility glycopeptide (vancomycin) associated to cephalosporin [9].…”

Section: Discussionmentioning

confidence: 99%

Pneumococcal Meningitis in a Child With Sickle Cell Anemia: A Case Report

Kiriazopulos

Pedroni

Occhi³

et al. 2015

Int J Clin Pediatr

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Children with sickle cell disease are mainly exposed to various infections, among which there is bacterial meningitis. We present a brief report of a pneumococcal meningitis, due to Streptococcus pneumoniae 33F, in a 3-year-old boy of African race with sickle cell anemia. He was vaccinated against Streptococcus pneumoniae with 13-valent vaccine, and he was also on antibiotic prophylaxis. The child has been successfully treated with cephalosporins for a complete duration of 6 weeks, while hospitalization lasted about 3 weeks. Ceftriaxone was replaced by cefotaxime to avoid risk of hemolysis, as we found in literature. During recovery, the little boy presented with osteomyelitis, so vancomycin was added to therapy with good results. Finally, neurosensorial deafness was found, thus the child was quickly directed to cochlear implant intervention. This case report revealed that sometimes pneumococcal vaccination and antibiotic prophylaxis are not enough to prevent pneumococcal meningitis in children with sickle cell disease. Moreover, we noticed that cefotaxime avoids autoimmune hemolysis, which may be fatal to anemic children, while vancomycin may help to prevent complications such as osteomyelitis.

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Treatment of Drug-resistant Pneumococcal Meningitis

Cited by 15 publications

References 54 publications

Opportunistic Infections Due to Inflammatory Bowel Disease Therapy

Opportunistic Infections Due to Inflammatory Bowel Disease Therapy

Rifampin use in acute community-acquired meningitis in intensive care units: the French retrospective cohort ACAM-ICU study

Pneumococcal Meningitis in a Child With Sickle Cell Anemia: A Case Report

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