[A case of penicillin-resistant pneumococcal meningitis and antibiotic susceptibility of Streptococcus pneumoniae isolated from children].
Recently, isolation of penicillin-resistant S. pneumoniae has been increasing. The first Japanese case of penicillin-resistant pneumococcal meningitis was reported in 1988. We experienced a case of a one-year-old boy with penicillin-resistant pneumococcal meningitis who dead on arrival on his third day of illness. Minimal inhibitory concentration (MIC) of penicillin G or S. pneumoniae isolated from cerebrospinal fluid and blood was 0.6 micrograms/ml. We evaluated the antibiotic susceptibility of 163 strains of S. pneumoniae isolated from children from 1985 to 1988. Penicillin G (PCG), ampicillin (ABPC), cefotaxime (CTX), imipenem (IPM), and vancomycin (VCM) had good susceptibilities to S. pneumoniae. Twelve of the 163 isolates (7.3%) were penicillin-resistant strains whose MIC of PCG were more than 0.1 microgram/ml, and all of them were intermediately resistant. The annual penicillin-resistant rates were 12.5% in 1985, 1.3% in 1986, 0% in 1986, and 19.0% in 1988. We also evaluated the MIC distribution and MIC90 of antibiotics available for meningitis against penicillin-sensitive and -resistant S. pneumoniae. MIC90 of PCG and ABPC against penicillin-resistant strains was 1.56 micrograms/ml, and it might be dangerous to use PCG or ABPC for central nervous system pneumococcal infections. MIC90 of IPM against penicillin-resistant strains was 0.1 microgram/ml, and that of VCM was 0.4 micrograms/ml. There was little fall of susceptibilities of resistant strains in IPM and VCM. We evaluated the MIC distribution and MIC70 of antibiotics for oral usage against penicillin-sensitive and -resistant S. pneumoniae. Although there were falls of susceptibilities of resistant strains in PCG and ABPC, these two antibiotics had the best susceptibilities among the oral antibiotics.
Department of Pediatrics, Chiba University School of Medicine.
K
K
Himi
S
S
Miyamoto
H
H
Ohshimi
H
H
Kuroki
N
N
Ishikawa
T
T
Yamazaki
M
M
Namba
H
H
Suzuki
S
S
Uehara
H
H
Niimi
D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D002648:Child; D006801:Humans; D007223:Infant; D008297:Male; D008586:Meningitis, Pneumococcal / Q000382:microbiology*; D008826:Microbial Sensitivity Tests; D010400:Penicillin G / Q000494:pharmacology*; D010403:Penicillin Resistance; D013296:Streptococcus pneumoniae / Q000187:drug effects* / Q000302:isolation & purification
D000900:Anti-Bacterial Agents; D010400:Penicillin G