Pneumococcal antibiotic resistance and rates of meningitis in children.
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.
Ryan
M W
MW
Department of Otolaryngology, University of Florida, Gainesville, USA.
Antonelli
P J
PJ
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*