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Penicillin-resistant pneumococcal meningitis in Israel
T Steinberg1, A Rachmel, Z Samra
1Department of Pediatrics, Schneider Children's Medical Center of Israel, Petah Tiqva, Israel.
Insights
Penicillin-resistant Streptococcus pneumoniae (PRP) meningitis is a global health threat. A case in Israel highlights treatment challenges and suggests vancomycin as a viable therapeutic option.
Area of Science:
- Infectious Diseases
- Microbiology
- Pediatrics
Background:
- Penicillin-resistant Streptococcus pneumoniae (PRP) poses a significant global health challenge.
- Meningitis caused by PRP has led to treatment failures and fatalities worldwide.
- No previous cases of PRP meningitis had been reported in Israel.
Observation:
- An 11-month-old infant in Israel presented with meningitis.
- The infant's condition did not improve with initial cefotaxime treatment.
- The causative agent was identified as penicillin-resistant Streptococcus pneumoniae.
Findings:
- The infant's PRP isolate exhibited minimal inhibitory concentrations (MICs) of 1.0 µg/ml for penicillin and cefotaxime, and 4.0 µg/ml for cefuroxime.
- Subsequent treatment with vancomycin resulted in a prompt clinical cure.
- This case represents the first reported instance of PRP meningitis in Israel.
Implications:
- Vancomycin is an effective treatment option for penicillin-resistant Streptococcus pneumoniae meningitis.
- The findings necessitate a review and potential update of meningitis treatment guidelines in Israel.
- Increased vigilance and awareness regarding PRP meningitis are crucial for healthcare providers in Israel.
Abstract:
Penicillin-resistant Streptococcus pneumoniae (PRP) is of worldwide concern. Treatment failures and fatalities of meningitis caused by PRP have been reported in other locations but not yet in Israel. We describe an 11-month-old infant with meningitis caused by PRP who failed to respond to initial treatment with cefotaxime. Vancomycin treatment caused a prompt cure. The minimal inhibitory concentrations of the isolate to penicillin, cefuroxime and cefotaxime were 1.0, 4.0 and 1.0 micrograms/ml, respectively. New guidelines for the treatment of meningitis in Israel are suggested.