title: Clinical outcomes of meningitis caused by Streptococcus pneumoniae in the era of antibiotic resistance.
abstract: 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.
authors.affiliation: Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. abf4@cdc.gov
authors.forename: A E
authors.initials: AE
authors.lastname: Fiore
authors.forename: J F
authors.initials: JF
authors.lastname: Moroney
authors.forename: M M
authors.initials: MM
authors.lastname: Farley
authors.forename: L H
authors.initials: LH
authors.lastname: Harrison
authors.forename: J E
authors.initials: JE
authors.lastname: Patterson
authors.forename: J H
authors.initials: JH
authors.lastname: Jorgensen
authors.forename: M
authors.initials: M
authors.lastname: Cetron
authors.forename: M S
authors.initials: MS
authors.lastname: Kolczak
authors.forename: R F
authors.initials: RF
authors.lastname: Breiman
authors.forename: A
authors.initials: A
authors.lastname: Schuchat
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002439:Cefotaxime / Q000494:pharmacology*; D018550:Cephalosporin Resistance; D002511:Cephalosporins / Q000494:pharmacology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008586:Meningitis, Pneumococcal / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology* / Q000473:pathology; D008875:Middle Aged; D011159:Population Surveillance; D012307:Risk Factors; D013296:Streptococcus pneumoniae / Q000187:drug effects*; D014640:Vancomycin / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D014640:Vancomycin; D002439:Cefotaxime