title: Pneumococcal antibiotic resistance and rates of meningitis in children.
abstract: OBJECTIVE
  Recent studies have shown alarmingly high rates of antibiotic resistance in Streptococcus pneumoniae isolates from patients with otitis media. A recent study has implicated resistant S pneumoniae for rising rates of acute mastoiditis. The purpose of this study was to determine whether S pneumoniae antibiotic resistance has similarly affected the rate of pediatric community-acquired meningitis, the most common intracranial complication of otitis media.
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  All cases of pediatric community-acquired meningitis treated at an academic tertiary care hospital during a 10-year period were reviewed, and meningitis rates were calculated as a proportion of yearly admissions.
  
  
  RESULTS
  The overall rate of meningitis decreased linearly during the study period (P = .001). This was largely because of a drop in the rate of Haemophilus influenzae meningitis (P = .001), corresponding with the introduction of H influenzae type B vaccine. Annual rates of S pneumoniae meningitis did not change. Only one case of S pneumoniae meningitis was due to a highly penicillin-resistant strain and isolates from four cases had intermediate sensitivity. Twenty-four of 83 cases were associated with antecedent acute otitis media and 63% of these had been treated with antibiotics before admission. Otitis media, as a cause of meningitis, did not increase during the study period.
  
  
  CONCLUSIONS
  S pneumoniae is responsible for a greater proportion of cases of pediatric community-acquired meningitis. However, this is because of a decline in the rate of H influenzae cases, not the rise in S pneumoniae antibiotic resistance.
authors.affiliation: Department of Otolaryngology, University of Florida, Gainesville, USA.
authors.forename: M W
authors.initials: MW
authors.lastname: Ryan
authors.forename: P J
authors.initials: PJ
authors.lastname: Antonelli
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000453:epidemiology / Q000382:microbiology; D004352:Drug Resistance, Microbial; D005431:Florida / Q000453:epidemiology; D006193:Haemophilus influenzae; D006801:Humans; D007223:Infant; D016920:Meningitis, Bacterial / Q000453:epidemiology* / Q000382:microbiology; D008583:Meningitis, Haemophilus / Q000453:epidemiology / Q000209:etiology; D008586:Meningitis, Pneumococcal / Q000453:epidemiology / Q000209:etiology / Q000382:microbiology; D010033:Otitis Media / Q000150:complications / Q000382:microbiology; D012189:Retrospective Studies; D013290:Streptococcal Infections; D013296:Streptococcus pneumoniae / Q000187:drug effects*