title: Clinical outcome of pneumococcal meningitis during the emergence of pencillin-resistant Streptococcus pneumoniae: an observational study.
abstract: BACKGROUND
  Prior to the availability of generic third-generation cephalosporins, penicillins were widely used for treatment of pneumococcal meningitis in developing countries despite concerns about rising levels of penicillin resistance among pneumococcal isolates. We examined the impact of penicillin resistance on outcomes of pneumococcal meningitis over a ten year period in an infectious diseases hospital in Brazil.
  
  
  METHODS
  Clinical presentation, antimicrobial therapy and outcomes were reviewed for 548 patients with culture-confirmed pneumococcal meningitis from December, 1995, to November, 2005. Pneumococcal isolates from meningitis patients were defined as penicillin-resistant if Minimum Inhibitory Concentrations for penicillin were greater than 0.06 μg/ml. Proportional hazards regression was used to identify risk factors for fatal outcomes.
  
  
  RESULTS
  During the ten-year period, ceftriaxone replaced ampicillin as first-line therapy for suspected bacterial meningitis. In hospital case-fatality for pneumococcal meningitis was 37%. Of 548 pneumococcal isolates from meningitis cases, 92 (17%) were resistant to penicillin. After controlling for age and severity of disease at admission, penicillin resistance was associated with higher case-fatality (Hazard Ratio [HR], 1.62; 95% Confidence Interval [CI], 1.08-2.43). Penicillin-resistance remained associated with higher case-fatality when initial therapy included ceftriaxone (HR, 1.68; 95% CI 1.02-2.76).
  
  
  CONCLUSIONS
  Findings support the use of third generation cephalosporin antibiotics for treatment of suspected pneumococcal meningitis even at low prevalence of pneumococcal resistance to penicillins.
authors: Gonçalo Moniz Research Center, Oswaldo Cruz Foundation, Brazilian Ministry of Health, Salvador, Brazil.
authors: Edilane L
authors: EL
authors: Gouveia
authors: Joice N
authors: JN
authors: Reis
authors: Brendan
authors: B
authors: Flannery
authors: Soraia M
authors: SM
authors: Cordeiro
authors: Josilene B T
authors: JB
authors: Lima
authors: Ricardo M
authors: RM
authors: Pinheiro
authors: Kátia
authors: K
authors: Salgado
authors: Ana Veronica
authors: AV
authors: Mascarenhas
authors: M Gloria
authors: MG
authors: Carvalho
authors: Bernard W
authors: BW
authors: Beall
authors: Mitermayer G
authors: MG
authors: Reis
authors: Albert I
authors: AI
authors: Ko
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001938:Brazil; D002648:Child; D002675:Child, Preschool; D005260:Female; D006761:Hospitals; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008586:Meningitis, Pneumococcal / Q000188:drug therapy* / Q000382:microbiology* / Q000401:mortality; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D010403:Penicillin Resistance; D013296:Streptococcus pneumoniae / Q000187:drug effects*; D016896:Treatment Outcome; D055815:Young Adult; D047090:beta-Lactams / Q000008:administration & dosage*
chemical_list: D000900:Anti-Bacterial Agents; D047090:beta-Lactams