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Pneumococcal antibiotic resistance and rates of meningitis in children

M W Ryan1, P J Antonelli

  • 1Department of Otolaryngology, University of Florida, Gainesville, USA.

The Laryngoscope
|June 14, 2000
PubMed
Abstract

Insights

Pediatric meningitis rates due to Streptococcus pneumoniae did not increase, despite rising antibiotic resistance. This is because rates of Haemophilus influenzae meningitis declined significantly.

Area of Science:

  • Pediatric infectious diseases
  • Bacterial meningitis epidemiology
  • Antibiotic resistance surveillance

Background:

  • High rates of antibiotic resistance in Streptococcus pneumoniae (S. pneumoniae) have been observed in otitis media.
  • Resistant S. pneumoniae strains have been linked to increased acute mastoiditis rates.
  • Community-acquired meningitis is a significant intracranial complication of otitis media in children.

Purpose of the Study:

  • To investigate the impact of S. pneumoniae antibiotic resistance on pediatric community-acquired meningitis rates.
  • To determine if S. pneumoniae resistance has contributed to an increase in meningitis cases.
  • To analyze trends in meningitis causative agents over a 10-year period.

Main Methods:

  • Retrospective chart review of pediatric community-acquired meningitis cases.
  • Analysis of meningitis rates as a proportion of yearly hospital admissions over a decade.
  • Evaluation of S. pneumoniae antibiotic resistance profiles in meningitis isolates.

Main Results:

  • Overall pediatric meningitis rates decreased linearly during the study period.
  • A significant decline in Haemophilus influenzae (H. influenzae) meningitis rates was observed, coinciding with H. influenzae type B vaccine introduction.
  • Annual rates of S. pneumoniae meningitis remained stable; only one case involved a highly penicillin-resistant strain.
  • Antecedent acute otitis media was associated with 24% of S. pneumoniae meningitis cases, with 63% pre-treated with antibiotics.

Conclusions:

  • S. pneumoniae now accounts for a larger proportion of pediatric meningitis cases due to a decrease in H. influenzae cases, not an increase in S. pneumoniae resistance.
  • Antibiotic resistance in S. pneumoniae has not driven an increase in pediatric community-acquired meningitis.
  • The introduction of the H. influenzae type B vaccine has significantly reduced meningitis incidence.

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