Related Experiment Video

Updated: Jan 4, 2026

Cefoperazone-treated Mouse Model of Clinically-relevant Clostridium difficile Strain R20291
06:51

Cefoperazone-treated Mouse Model of Clinically-relevant Clostridium difficile Strain R20291

Published on: December 10, 2016

13.1K

Emergence of Ceftriaxone Resistance during a Case of Pneumococcal Meningitis with Fatal Evolution

A Mizrahi1,2, J C Marvaud2, B Pilmis2,3

  • 1Laboratoire de Microbiologie Clinique, Groupe Hospitalier Paris Saint-Joseph, Paris, France amizrahi@hpsj.fr.

Antimicrobial Agents and Chemotherapy
|November 13, 2019
PubMed

Insights

A man treated for pneumococcal meningitis developed neurological decline due to vasculitis. This occurred despite effective ceftriaxone levels, as the bacteria developed resistance through a PBP2X mutation.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Microbiology

Background:

  • Bacterial meningitis requires prompt antibiotic treatment.
  • Ceftriaxone is a common antibiotic for Streptococcus pneumoniae meningitis.
  • Dexamethasone may be used as an adjunct therapy.

Observation:

  • A 62-year-old man with S. pneumoniae meningitis initially improved with ceftriaxone and dexamethasone.
  • Neurological deterioration occurred despite therapeutic serum and CSF ceftriaxone concentrations.
  • Vasculitis was identified as the cause of neurological decline.

Findings:

  • A secondary S. pneumoniae isolate from ventricular fluid showed increased minimum inhibitory concentrations (MICs) to third-generation cephalosporins (3GC).
  • Genetic analysis revealed a mutation in penicillin-binding protein 2X (PBP2X) in the resistant isolate.
  • This PBP2X mutation is associated with 3GC resistance in S. pneumoniae.

Implications:

  • Antibiotic resistance can emerge during treatment, even with seemingly effective drug concentrations.
  • Treatment failure in bacterial meningitis may be linked to the development of resistant strains.
  • Understanding resistance mechanisms like PBP2X mutations is crucial for managing difficult-to-treat infections.
Keywords:
3GC resistanceStreptococcus pneumoniaemeningitismeningitis-related delayed cerebral injurypenicillin-binding proteintreatment failure

More Related Videos

Testing the Role of Multicopy Plasmids in the Evolution of Antibiotic Resistance09:00

Testing the Role of Multicopy Plasmids in the Evolution of Antibiotic Resistance

Published on: May 2, 2018

12.3K
Inducing Meningococcal Meningitis Serogroup C in Mice via Intracisternal Delivery10:03

Inducing Meningococcal Meningitis Serogroup C in Mice via Intracisternal Delivery

Published on: November 5, 2019

7.6K

Related Concept Videos

Development of Antibiotic Resistance01:30

Development of Antibiotic Resistance

Antibiotic resistance is a major public health concern that arises when bacteria evolve mechanisms to withstand the effects of antibiotic treatments. This resistance can be intrinsic, acquired through genetic mutations, or transferred between bacteria via horizontal gene transfer. The development of antibiotic resistance poses significant challenges in treating bacterial infections and necessitates ongoing research to develop new therapeutic strategies.Intrinsic resistance occurs when bacterial...
1.1K
Pneumonia IV: Management01:28

Pneumonia IV: Management

The treatment of pneumonia varies based on its severity and the causative pathogen. Here is a structured approach to managing pneumonia, integrating pharmaceutical and supportive care strategies.
Bacterial Pneumonia Treatment
For bacterial pneumonia, antibiotics serve as the cornerstone of therapy. Initial treatment often begins with empirical antibiotics, tailored to the anticipated causative organism and adjusted based on culture results. Key antibiotic choices include:
703
Pharmaceutical Alternatives: Stability-Related Therapeutic Nonequivalence01:22

Pharmaceutical Alternatives: Stability-Related Therapeutic Nonequivalence

Generic intravenous (IV) drugs are considered bioequivalent to their branded counterparts due to their 100% bioavailability upon administration. However, variations in stability among different drug products can significantly influence their therapeutic performance, even if they are pharmaceutically equivalent.Cefuroxime, a prophylactic antimicrobial, is often used as a single-dose IV injection for patients undergoing coronary artery bypass grafting surgery. A 3 g dose typically provides...
152
Acute Pyelonephritis II: Diagnostic Studies and Management01:28

Acute Pyelonephritis II: Diagnostic Studies and Management

Introduction:For diagnosing acute pyelonephritis, a comprehensive patient history is collected to identify symptoms such as dysuria, frequent or urgent urination, flank pain, or costovertebral angle (CVA) tenderness that may suggest a kidney infection.Physical ExaminationDuring the physical examination, CVA tenderness is assessed. This involves gentle percussion over the costovertebral angle, where tenderness often indicates a kidney infection.Diagnostic TestsUrinalysis: Used to identify white...
249
Antimicrobial Effectiveness01:28

Antimicrobial Effectiveness

The effectiveness of antimicrobial agents depends on various factors influencing their ability to eliminate microbial populations. Larger microbial populations require more time for complete eradication, emphasizing the importance of population size analysis when evaluating antimicrobial efficacy.Microbial resistance to antimicrobial agents varies significantly. Highly resilient microorganisms include endospores, gram-negative bacteria, and non-enveloped viruses, while prions are exceptionally...
862
Antibiotic Selection00:57

Antibiotic Selection

Overview
59.3K