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Published on: February 9, 2011

Post operative penicillin-non-susceptible Streptococcus pneumoniae meningitis and septic shock in a child

Pagakrong Lumbiganon1, Palakorn Surakunprapha, Pope Kosalaraksa

  • 1Department of Pediatrics, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand. paglum@kku.ac.th

Journal of the Medical Association of Thailand = Chotmaihet Thangphaet
|June 18, 2008
PubMed

Insights

A rare case of post-operative meningitis in a child with fronto-ethmoidal encephalomeningocele was successfully treated. This highlights the importance of considering penicillin-non-susceptible Streptococcus pneumoniae in serious infections.

Area of Science:

  • Neuroscience
  • Infectious Diseases
  • Pediatric Surgery

Background:

  • Fronto-ethmoidal encephalomeningocele repair is a complex neurosurgical procedure.
  • Post-operative infections, including meningitis, are significant risks in pediatric neurosurgery.
  • Increasing prevalence of antibiotic-resistant bacteria poses a challenge to empirical treatment strategies.

Observation:

  • A one-year-old girl developed wound infection, purulent meningitis, and septic shock five hours after fronto-ethmoidal encephalomeningocele repair.
  • Cerebrospinal fluid and eye discharge cultures identified Streptococcus pneumoniae.
  • The isolate exhibited penicillin-non-susceptible characteristics (MIC of penicillin = 1.0 ug/ml).

Findings:

  • Empirical treatment with ceftazidime and vancomycin was initiated.
  • Antibiotic therapy was switched to cefotaxime (300 mg/kg/day) based on susceptibility testing.
  • The patient achieved a complete recovery following appropriate antibiotic management.

Implications:

  • Penicillin-non-susceptible Streptococcus pneumoniae should be considered in the differential diagnosis of severe post-operative infections of the face and neck.
  • This case underscores the need for vigilant monitoring and tailored antibiotic therapy in pediatric neurosurgical patients.
  • Awareness of rising penicillin resistance in S. pneumoniae is crucial for optimizing treatment outcomes in surgical site infections.

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