title: Clinical features and in vitro antimicrobial susceptibilities of community-acquired Klebsiella pneumoniae meningitis in Taiwan.
abstract: Twenty-seven adult patients were identified as having community-acquired Klebsiella pneumoniae meningitis. The K. pneumoniae isolates, collected from cerebrospinal fluid samples, were tested for in vitro antimicrobial susceptibilities. The prognostic factors of these 27 patients were also analysed. All of the third- and fourth-generation cephalosporins tested, as well as monobactam, carbapenem and ciprofloxacin, had good activities against the isolated K. pneumoniae strains. None of the clinical isolates was detected as being an extended-spectrum beta-lactamase-producing pathogen. Among the third- and fourth-generation cephalosporins, ceftizoxime, cefepime, ceftriaxone and cefotaxime had superior activities, with MIC90s about four- to eight-fold lower than those of ceftazidime and moxalactam. Mortality rates of patients classified by different antimicrobial agents were as follows: ceftazidime 38% (8/21) and cefepime 16.7% (1/6). The presence of septic shock and the initial level of consciousness at the start of appropriate antimicrobial therapy were the major determinants of survival and neurological outcomes in these 27 patients. Early diagnosis and choice of appropriate antibiotics according to antimicrobial susceptibilities may improve therapeutic outcomes.
authors.affiliation: Department of Pharmacy, Chang Gung Memorial Hospital-Kaohsiung, 123 Ta Pei Road, Niao Sung Hsiang, Kaohsiung, Taiwan.
authors.forename: Ping-Yu
authors.initials: PY
authors.lastname: Lee
authors.forename: Wen-Neng
authors.initials: WN
authors.lastname: Chang
authors.forename: Cheng-Hsien
authors.initials: CH
authors.lastname: Lu
authors.forename: Mei-Wen
authors.initials: MW
authors.lastname: Lin
authors.forename: Ben-Chung
authors.initials: BC
authors.lastname: Cheng
authors.forename: Chun-Chih
authors.initials: CC
authors.lastname: Chien
authors.forename: Chin-Jung
authors.initials: CJ
authors.lastname: Chang
authors.forename: Hsueh-Wen
authors.initials: HW
authors.lastname: Chang
mesh_terms: D000328:Adult; D000368:Aged; D000890:Anti-Infective Agents / Q000627:therapeutic use; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D005260:Female; D006801:Humans; D007710:Klebsiella Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D007711:Klebsiella pneumoniae / Q000187:drug effects; D008297:Male; D016920:Meningitis, Bacterial / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D011379:Prognosis; D013624:Taiwan / Q000453:epidemiology
chemical_list: D000890:Anti-Infective Agents