Is adjunctive corticosteroid beneficial in pneumococcal meningitis in a region with high rates of resistance to penicillin and ceftriaxone?
The role of adjunctive corticosteroids remains controversial in meningitis by penicillin-resistant pneumococci. We determined the effect of adjunctive corticosteroids in adults with pneumococcal meningitis in a region with a high rate of penicillin resistance. A multicenter, retrospective cohort study was conducted between 1998 and 2008 in Korea. The mortality and neurological sequelae were evaluated. Among 93 patients with pneumococcal meningitis, adequate adjunctive corticosteroids were given in 45.2%. The penicillin resistance rate was 60.0%, and 42.1% were nonsusceptible to ceftriaxone. The 30-day mortality rates in the group receiving adequate corticosteroid therapy, the group in which corticosteroid was not given, and that inadequately given were 24.3, 31.6, and 27.3%, respectively, and there was no difference between the groups. The rates of development of neurological sequelae were 34.3, 33.3, and 43.5%, respectively. Multivariate analysis showed that adequate corticosteroids did not reduce mortality (HR 0.773, 95% CI 0.293-2.040) and neurologic sequelae (HR 0.604, CI 0.262-1.393). Propensity-adjusted analysis showed that adjunctive corticosteroid was not associated with time to death (HR 0.949, CI 0.374-2.408), however, a decreasing tendency was shown in neurologic sequelae in the adequate corticosteroid group (HR 0.479, CI 0.207-1.110). In conclusion, adjunctive corticosteroids did not affect mortality in adults with pneumococcal meningitis in a region with high rates of resistance to penicillin and ceftriaxone; however, the patients receiving adequate corticosteroid therapy tended to develop neurologic sequelae less frequently.
Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Soo-Youn
SY
Moon
Doo Ryeon
DR
Chung
Shin-Woo
SW
Kim
Hyun Ha
HH
Chang
Hyuck
H
Lee
Dong Sik
DS
Jung
Yeon-Sook
YS
Kim
Sook In
SI
Jung
Seong Yeol
SY
Ryu
Sang Taek
ST
Heo
Chisook
C
Moon
Hyun Kyun
HK
Ki
Jun Seong
JS
Son
Ki Tae
KT
Kwon
Sang Yop
SY
Shin
Jin Seo
JS
Lee
Seung Soon
SS
Lee
Ji-Young
JY
Rhee
Cheol-In
CI
Kang
Kyong Ran
KR
Peck
Jae-Hoon
JH
Song
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000009:adverse effects; D002443:Ceftriaxone / Q000009:adverse effects; D015331:Cohort Studies; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008586:Meningitis, Pneumococcal / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality*; D008875:Middle Aged; D010403:Penicillin Resistance / Q000187:drug effects; D010406:Penicillins / Q000009:adverse effects; D012189:Retrospective Studies; D013296:Streptococcus pneumoniae / Q000472:pathogenicity; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents; D010406:Penicillins; D002443:Ceftriaxone