The emergence of resistant pneumococcal meningitis--implications for empiric therapy

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Following in Real Time the Impact of Pneumococcal Virulence Factors in an Acute Mouse Pneumonia Model Using Bioluminescent Bacteria

Published on: February 23, 2014

P McMaster1, P McIntyre, R Gilmour

  • 1Department of Immunology and Infectious Diseases, The Children's Hospital at Westmead, PO Box 3515, Parramatta, NSW 2124, Australia.

Archives of Disease in Childhood
|August 24, 2002
PubMed
Abstract

Insights

Delayed lumbar puncture in pneumococcal meningitis increases disease severity. Empiric vancomycin is most justified for delayed lumbar punctures, but can be withheld if Gram-positive diplococci are not seen on early lumbar puncture.

Area of Science:

  • Pediatric Infectious Diseases
  • Bacterial Meningitis Pathogenesis
  • Antibiotic Resistance Epidemiology

Background:

  • Penicillin and cephalosporin resistance in pneumococcal meningitis prompted vancomycin recommendations.
  • Limited data exist to evaluate the efficacy of this empiric vancomycin policy.

Purpose of the Study:

  • To assess management and clinical outcomes of pneumococcal meningitis in children.
  • To correlate outcomes with antibiotic therapy in an area of increasing antibiotic resistance.

Main Methods:

  • Retrospective review of 104 pediatric pneumococcal meningitis cases in Sydney, Australia (1994-1999).
  • Analysis of lumbar puncture timing, antibiotic use, and disease severity.
  • Evaluation of penicillin resistance trends.

Main Results:

  • Penicillin resistance increased from 0% to 20% during the study period.
  • Early lumbar puncture (prior to antibiotics) occurred in only 55% of cases.
  • Delayed or no lumbar puncture was associated with significantly increased severe disease (42%-62%) compared to early lumbar puncture (28%).
  • Empiric vancomycin use did not correlate with patient outcomes.

Conclusions:

  • Lumbar puncture is frequently delayed in pediatric pneumococcal meningitis.
  • Empiric vancomycin is most indicated when lumbar puncture is deferred due to increased disease severity.
  • Vancomycin may be withheld if Gram-positive diplococci are absent on early lumbar puncture results.

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