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[Pneumococcal meningitis. 6-year review]
M L Aísa1, A Esteban, C Villuendas
1Servicio de Microbiología, Hospital Miguel Servet, Zaragoza.
Abstract:
We have reviewed 29 episodes of pneumococcal meningitis seen in a 6-year period (1983-1988) in 11 pediatric patients and 16 adults. An underlying disease or condition was present in 81.5% of cases, in 55.5% there was an anatomical defect, either congenital, acquired or traumatic in origin. Gram stain of CSF was positive in 86% of cases, and latex test was positive in the 22 CSF samples analyzed with this technique. MIC for penicillin ranges from 1 to 2 mcg/ml in 51.7% of cases. These isolates were also resistant to tetracycline (100%), trimethoprim-sulfamethoxazole (100%) and chloramphenicol (87%). All strains isolated were sensitive to vancomycin, rifampin and cefotaxime. Of all 14 episodes due to penicillin-sensitive strains, 10 cases were treated with this drug and in 4 cases, third generation cephalosporins were prescribed. All cases showed good clinical response. Of all 15 episodes due to penicillin-resistant strains, vancomycin was used first in 10 cases, cefotaxime in three, moxalactam in one and ampicillin plus chloramphenicol in another. Treatment failures (one in cefotaxime and one in moxalactam group) were solved with vancomycin. Of all 12 patients treated with vancomycin, clinical and microbiological cure was achieved in 10 cases. Two additional patients died, one with sterile CSF after 45 days of admission and one few hours after admission. Our data give support to vancomycin as a useful therapeutic option in the treatment of pneumococcal meningitis due to penicillin-resistant strains.
Insights
Pneumococcal meningitis treatment in adults and children showed high rates of penicillin resistance. Vancomycin proved effective for penicillin-resistant strains, offering a crucial therapeutic option.
Area of Science:
- Infectious Diseases
- Microbiology
- Clinical Medicine
Background:
- Pneumococcal meningitis remains a significant cause of morbidity and mortality.
- Underlying conditions and anatomical defects are common in patients with pneumococcal meningitis.
- Antimicrobial resistance, particularly to penicillin, poses a challenge in treatment.
Purpose of the Study:
- To evaluate treatment outcomes for pneumococcal meningitis.
- To assess the efficacy of various antibiotics, including vancomycin, against penicillin-resistant Streptococcus pneumoniae strains.
- To identify effective therapeutic options for pneumococcal meningitis.
Main Methods:
- Retrospective review of 29 pneumococcal meningitis cases over a 6-year period (1983-1988).
- Analysis of patient demographics, underlying conditions, and anatomical defects.
- Microbiological analysis including Gram stain, latex test, and minimum inhibitory concentrations (MICs) for various antibiotics.
- Evaluation of treatment regimens and clinical responses.
Main Results:
- Penicillin resistance was observed in a significant proportion of isolates.
- Vancomycin, rifampin, and cefotaxime demonstrated sensitivity against all isolated strains.
- Vancomycin achieved clinical and microbiological cure in 10 out of 12 patients treated for penicillin-resistant pneumococcal meningitis.
- Treatment failures with cefotaxime and moxalactam were successfully resolved with vancomycin.
Conclusions:
- Vancomycin is a valuable therapeutic option for treating pneumococcal meningitis caused by penicillin-resistant strains.
- Early identification of antimicrobial resistance patterns is crucial for effective treatment selection.
- Further research into optimal treatment strategies for resistant pneumococcal meningitis is warranted.