Clinical Outcomes of Meningitis Caused by Streptococcus pneumoniae in the Era of Antibiotic Resistance

作者：Anthony E. Fiore, John F. Moroney, Monica M. Farley, Lee H. Harrison, JAN EVANS PATTERSON, James H. Jorgensen, Martín S. Cetron, MARGARETTE S. KOLCZAK, Robert F. Breiman, Anne Schuchat · 发表于：Clinical Infectious Diseases · 年份：2000 · DOI：10.1086/313606 · 被引用次数：89 · 研究领域：Pneumonia and Respiratory Infections、Bacterial Infections and Vaccines、Streptococcal Infections and Treatments

Limited data are available on clinical outcomes of meningitis due to cefotaxime-nonsusceptible Streptococcus pneumoniae. We analyzed data from 109 cases of pneumococcal meningitis in Atlanta, Baltimore, and San Antonio, which were identified through population-based active surveillance from November 1994 to April 1996. Pneumococcal isolates from 9% of the cases were resistant to cefotaxime, and isolates from 11% had intermediate susceptibility. Children were more likely to have cephalosporin-nonsusceptible pneumococcal meningitis, but mortality was significantly higher among adults aged 18-64 years. Vancomycin was given upon admission to 29% of patients, and within 48 h of admission to 52%. Nonsusceptibility to cefotaxime was not associated with the following outcomes: increased mortality, prolonged length of hospital or intensive care unit (ICU) stay, requirement of intubation or oxygen, ICU care, discharge to another medical or long-term-care facility, or neurological deficit. Empirical use of vancomycin, current prevalence of drug-resistant S. pneumoniae, and degree of nonsusceptibility to cefotaxime may have influenced these findings.