Related Experiment Videos
Prolonged pneumococcal meningitis due to an organism with increased resistance to penicillin
Abstract:
For more than 30 years, penicillin has been the agent of choice for pneumococcal infections. During this time the majority of strains of Streptococcus pneumoniae have been highly susceptible to penicillin. However, during the last ten years there have been sporadic reports of pneumococci with increased resistance to penicillin. The case report of an 18-month-old white boy with meningitis due to a strain of S. pneumoniae with increased resistance to penicillin is presented. The MIC of the organism to penicillin was 0.2 mug/ml and the MBC 0.39 mug/ml. The patient had normal immunity and no demonstrable sequestered focus of infection but failed to respond to appropriate doses of intravenous penicillin. Treatment with chloramphenicol caused a dramatic bacteriologic and clinical response. This experience reemphasizes the existence of pneumococcal strains of intermediate penicillin sensitivity and the importance of in vitro susceptibility tests.
Insights
Penicillin resistance in Streptococcus pneumoniae is increasing. A child with meningitis resistant to penicillin responded well to chloramphenicol, highlighting the need for susceptibility testing.
Area of Science:
- Infectious Diseases
- Microbiology
- Clinical Medicine
Background:
- Penicillin has been the primary treatment for Streptococcus pneumoniae infections for over 30 years.
- Most Streptococcus pneumoniae strains remain susceptible to penicillin, but resistance has emerged sporadically.
- Increased penicillin resistance in Streptococcus pneumoniae poses a growing clinical challenge.
Observation:
- A case of an 18-month-old boy with meningitis caused by a penicillin-resistant Streptococcus pneumoniae strain is reported.
- The patient exhibited intermediate penicillin resistance (MIC 0.2 µg/ml, MBC 0.39 µg/ml).
- Despite appropriate intravenous penicillin dosing, the patient did not respond to treatment.
Findings:
- The patient's infection was successfully treated with chloramphenicol, showing a significant clinical and bacteriologic response.
- This case demonstrates the clinical relevance of intermediate penicillin resistance in Streptococcus pneumoniae.
- In vitro susceptibility testing is crucial for guiding effective antibiotic selection.
Implications:
- The findings underscore the importance of monitoring and testing for penicillin resistance in Streptococcus pneumoniae.
- Alternative antibiotics, such as chloramphenicol, may be necessary for treating infections caused by resistant strains.
- Continued surveillance of antimicrobial resistance patterns is essential for public health.