title: Pneumococcal meningitis in children: relationship of antibiotic resistance to clinical characteristics and outcomes.
abstract: BACKGROUND
  The relationship of antibiotic susceptibility to clinical outcome in children with pneumococcal meningitis is uncertain. Previous studies have been limited by inclusion of relatively few patients infected with nonsusceptible pneumococci and inconsistent use of empiric vancomycin.
  
  
  METHODS
  Medical records of 86 children with culture-confirmed pneumococcal meningitis at a single institution from October, 1991, to October, 1999, were retrospectively reviewed, and differences in presentation and outcome based on antibiotic susceptibility of pneumococcal isolates were assessed.
  
  
  RESULTS
  Of 86 isolates 34 were nonsusceptible to penicillin (12 resistant). Of 60 isolates for which cefotaxime susceptibility data were available, 17 were nonsusceptible (12 resistant). Antibiotic susceptibility was not significantly associated with death, intensive care unit admission, mechanical ventilation, focal neurologic deficits, seizures, secondary fever, abnormal neuroimaging studies or hospital days. Children with penicillin-resistant isolates had significantly higher median blood leukocyte counts (24,100/microliter vs. 15,700/microliter, P = 0.03) and lower median CSF protein concentrations (85 mg/dl vs. 219 mg/dl, P = 0.04), were more likely to have a CSF glucose concentration of > or = 50 mg/dl (7 of 11 vs. 15 of 68, P = 0.009) and had lower rates of sensorineural hearing loss (1 of 8 vs. 25 of 40, P = 0.02) than children with isolates that were not resistant to penicillin. Children with cefotaxime-nonsusceptible isolates had an increased median duration of primary fever compared with those with nonsusceptible strains (6 days vs. 3.5 days, P = 0.02).
  
  
  CONCLUSIONS
  In children with pneumococcal meningitis, penicillin resistance was associated with a reduced risk of hearing loss, while cefotaxime resistance was associated with a longer duration of fever. Other outcome measures were not significantly influenced by the antibiotic susceptibility of pneumococcal isolates.
authors.affiliation: Department of Pediatrics, University of Tennessee Health Science Center, Le Bonheur Children's Medical Center, Memphis, TN, USA. sbuckingham@utmem.edu
authors.forename: S C
authors.initials: SC
authors.lastname: Buckingham
authors.forename: J A
authors.initials: JA
authors.lastname: McCullers
authors.forename: J
authors.initials: J
authors.lastname: Luján-Zilbermann
authors.forename: K M
authors.initials: KM
authors.lastname: Knapp
authors.forename: K L
authors.initials: KL
authors.lastname: Orman
authors.forename: B K
authors.initials: BK
authors.lastname: English
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents; D002555:Cerebrospinal Fluid / Q000187:drug effects / Q000382:microbiology; D002675:Child, Preschool; D004359:Drug Therapy, Combination / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008499:Medical Records; D008586:Meningitis, Pneumococcal / Q000175:diagnosis* / Q000188:drug therapy* / Q000401:mortality; D008826:Microbial Sensitivity Tests; D010403:Penicillin Resistance; D011336:Probability; D011379:Prognosis; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents