%0 Journal Article
%T Clinical outcome of pneumococcal meningitis during the emergence of pencillin-resistant Streptococcus pneumoniae: an observational study
%A Edilane L Gouveia
%A Joice N Reis
%A Brendan Flannery
%A Soraia M Cordeiro
%A Josilene BT Lima
%A Ricardo M Pinheiro
%A K¨¢tia Salgado
%A Ana Mascarenhas
%A M Gloria Carvalho
%A Bernard W Beall
%A Mitermayer G Reis
%A Albert I Ko
%J BMC Infectious Diseases
%D 2011
%I BioMed Central
%R 10.1186/1471-2334-11-323
%X Clinical presentation, antimicrobial therapy and outcomes were reviewed for 548 patients with culture-confirmed pneumococcal meningitis from December, 1995, to November, 2005. Pneumococcal isolates from meningitis patients were defined as penicillin-resistant if Minimum Inhibitory Concentrations for penicillin were greater than 0.06 ¦Ìg/ml. Proportional hazards regression was used to identify risk factors for fatal outcomes.During the ten-year period, ceftriaxone replaced ampicillin as first-line therapy for suspected bacterial meningitis. In hospital case-fatality for pneumococcal meningitis was 37%. Of 548 pneumococcal isolates from meningitis cases, 92 (17%) were resistant to penicillin. After controlling for age and severity of disease at admission, penicillin resistance was associated with higher case-fatality (Hazard Ratio [HR], 1.62; 95% Confidence Interval [CI], 1.08-2.43). Penicillin-resistance remained associated with higher case-fatality when initial therapy included ceftriaxone (HR, 1.68; 95% CI 1.02-2.76).Findings support the use of third generation cephalosporin antibiotics for treatment of suspected pneumococcal meningitis even at low prevalence of pneumococcal resistance to penicillins.Among bacterial causes of meningitis, Streptococcus pneumoniae (the pneumococcus) is associated with the highest case-fatality and is the most likely to leave survivors with permanent sequelae. For the year 2000, the WHO's Global Burden of Disease project estimated 100,000 cases of pneumococcal meningitis occurred among children <5 worldwide, with higher than 50% case-fatality [1]. Over 95% of the pneumococcal deaths occurred in developing countries.Prior to the identification of penicillin-resistant pneumococci, penicillin therapy was the standard treatment for pneumococcal meningitis. Recommendations of the American Academy of Pediatrics and Infectious Diseases Society of America for first-line treatment of pneumococcal meningitis were changed to a 3rd generation ceph
%U http://www.biomedcentral.com/1471-2334/11/323