title: Mortality indicators in pneumococcal meningitis: therapeutic implications.
abstract: BACKGROUND
  The aim of this study was to delineate mortality indicators in pneumococcal meningitis with special emphasis on therapeutic implications.
  
  
  METHODS
  This retrospective, multicenter cohort study involved a 15-year period (1998-2012). Culture-positive cases (n=306) were included solely from 38 centers.
  
  
  RESULTS
  Fifty-eight patients received ceftriaxone plus vancomycin empirically. The rest were given a third-generation cephalosporin alone. Overall, 246 (79.1%) isolates were found to be penicillin-susceptible, 38 (12.2%) strains were penicillin-resistant, and 22 (7.1%) were oxacillin-resistant (without further minimum inhibitory concentration testing for penicillin). Being a critical case (odds ratio (OR) 7.089, 95% confidence interval (CI) 3.230-15.557) and age over 50 years (OR 3.908, 95% CI 1.820-8.390) were independent predictors of mortality, while infection with a penicillin-susceptible isolate (OR 0.441, 95% CI 0.195-0.996) was found to be protective. Empirical vancomycin use did not provide significant benefit (OR 2.159, 95% CI 0.949-4.912).
  
  
  CONCLUSIONS
  Ceftriaxone alone is not adequate in the management of pneumococcal meningitis due to penicillin-resistant pneumococci, which is a major concern worldwide. Although vancomycin showed a trend towards improving the prognosis of pneumococcal meningitis, significant correlation in statistical terms could not be established in this study. Thus, further studies are needed for the optimization of pneumococcal meningitis treatment.
authors.affiliation: GATA Haydarpasa Training Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey. Electronic address: hakanerdem1969@yahoo.com.
authors.forename: Hakan
authors.initials: H
authors.lastname: Erdem
authors.affiliation: Cumhuriyet University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Sivas, Turkey.
authors.forename: Nazif
authors.initials: N
authors.lastname: Elaldi
authors.affiliation: Antalya Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Antalya, Turkey.
authors.forename: Nefise
authors.initials: N
authors.lastname: Öztoprak
authors.affiliation: Haseki Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
authors.forename: Gonul
authors.initials: G
authors.lastname: Sengoz
authors.affiliation: Lutfi Kirdar Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
authors.forename: Oznur
authors.initials: O
authors.lastname: Ak
authors.affiliation: Karadeniz Technical University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Trabzon, Turkey.
authors.forename: Selcuk
authors.initials: S
authors.lastname: Kaya
authors.affiliation: Haydarpasa Numune Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
authors.forename: Asuman
authors.initials: A
authors.lastname: Inan
authors.affiliation: Osmangazi University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Eskisehir, Turkey.
authors.forename: Saygın
authors.initials: S
authors.lastname: Nayman-Alpat
authors.affiliation: Erciyes University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Kayseri, Turkey.
authors.forename: Ayşegül
authors.initials: A
authors.lastname: Ulu-Kilic
authors.affiliation: Private Erzurum Sifa Hospital, Department of Infectious Diseases and Clinical Microbiology, Erzurum, Turkey.
authors.forename: Abdullah Umut
authors.initials: AU
authors.lastname: Pekok
authors.affiliation: Sisli Etfal Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
authors.forename: Alper
authors.initials: A
authors.lastname: Gunduz
authors.affiliation: Cumhuriyet University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Sivas, Turkey.
authors.forename: Mustafa G
authors.initials: MG
authors.lastname: Gozel
authors.affiliation: Haseki Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
authors.forename: Filiz
authors.initials: F
authors.lastname: Pehlivanoglu
authors.affiliation: Bakırkoy Dr. Sadi Konuk Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
authors.forename: Kadriye
authors.initials: K
authors.lastname: Yasar
authors.affiliation: Ondokuz Mayis University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Samsun, Turkey.
authors.forename: Hava
authors.initials: H
authors.lastname: Yılmaz
authors.affiliation: GATA Haydarpasa Training Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Hatipoglu
authors.affiliation: Diskapi Yildirim Beyazit Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey.
authors.forename: Gonul
authors.initials: G
authors.lastname: Cicek-Senturk
authors.affiliation: Suleyman Demirel University, School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Isparta, Turkey.
authors.forename: Fusun Z
authors.initials: FZ
authors.lastname: Akcam
authors.affiliation: Hacettepe University, School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey.
authors.forename: Ahmet C
authors.initials: AC
authors.lastname: Inkaya
authors.affiliation: Uludag University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Bursa, Turkey.
authors.forename: Esra
authors.initials: E
authors.lastname: Kazak
authors.affiliation: Firat University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Elazig, Turkey.
authors.forename: Ayşe
authors.initials: A
authors.lastname: Sagmak-Tartar
authors.affiliation: Dicle University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Diyarbakir, Turkey.
authors.forename: Recep
authors.initials: R
authors.lastname: Tekin
authors.affiliation: Haydarpasa Numune Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
authors.forename: Derya
authors.initials: D
authors.lastname: Ozturk-Engin
authors.affiliation: Inonu University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Malatya, Turkey.
authors.forename: Yasemin
authors.initials: Y
authors.lastname: Ersoy
authors.affiliation: Ege University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Izmir, Turkey.
authors.forename: Oguz Resat
authors.initials: OR
authors.lastname: Sipahi
authors.affiliation: Ankara Atatürk Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey.
authors.forename: Tumer
authors.initials: T
authors.lastname: Guven
authors.affiliation: Ankara Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey.
authors.forename: Gunay
authors.initials: G
authors.lastname: Tuncer-Ertem
authors.affiliation: Erciyes University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Kayseri, Turkey.
authors.forename: Selma
authors.initials: S
authors.lastname: Alabay
authors.affiliation: Firat University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Elazig, Turkey.
authors.forename: Ayhan
authors.initials: A
authors.lastname: Akbulut
authors.affiliation: Istanbul University Cerrahpasa School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
authors.forename: Ilker I
authors.initials: II
authors.lastname: Balkan
authors.affiliation: GATA Haydarpasa Training Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
authors.forename: Oral
authors.initials: O
authors.lastname: Oncul
authors.affiliation: Koc University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
authors.forename: Birsen
authors.initials: B
authors.lastname: Cetin
authors.affiliation: Dicle University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Diyarbakir, Turkey.
authors.forename: Saim
authors.initials: S
authors.lastname: Dayan
authors.affiliation: Mersin University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Mersin, Turkey.
authors.forename: Gulden
authors.initials: G
authors.lastname: Ersoz
authors.affiliation: Gulhane Medical Academy, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey.
authors.forename: Ahmet
authors.initials: A
authors.lastname: Karakas
authors.affiliation: Medeniyet University, Goztepe Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
authors.forename: Nail
authors.initials: N
authors.lastname: Ozgunes
authors.affiliation: Onsekiz Mart University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Canakkale, Turkey.
authors.forename: Alper
authors.initials: A
authors.lastname: Sener
authors.affiliation: Baskent University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey.
authors.forename: Aysegul
authors.initials: A
authors.lastname: Yesilkaya
authors.affiliation: Recep Tayyip Erdoğan University, School of Medicine, Department of Department of Infectious Diseases and Clinical Microbiology, Rize, Turkey.
authors.forename: Ayse
authors.initials: A
authors.lastname: Erturk
authors.affiliation: Kocaeli University School of Medicine, Department of Department of Infectious Diseases and Clinical Microbiology, Izmit, Turkey.
authors.forename: Sibel
authors.initials: S
authors.lastname: Gundes
authors.affiliation: Sakarya University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Sakarya, Turkey.
authors.forename: Oguz
authors.initials: O
authors.lastname: Karabay
authors.affiliation: Izzet Baysal University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Bolu, Turkey.
authors.forename: Fatma
authors.initials: F
authors.lastname: Sirmatel
authors.affiliation: Izmir Bozyaka Training and Research Hospital, Department of Infectious diseases and Clinical Microbiology, Izmir, Turkey.
authors.forename: Selma
authors.initials: S
authors.lastname: Tosun
authors.affiliation: GATA Haydarpasa Training Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
authors.forename: Vedat
authors.initials: V
authors.lastname: Turhan
authors.affiliation: Ankara University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey.
authors.forename: Aysun
authors.initials: A
authors.lastname: Yalci
authors.affiliation: Bezmi Alem Vakif University, School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
authors.forename: Yasemin
authors.initials: Y
authors.lastname: Akkoyunlu
authors.affiliation: Kafkas University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Kars, Turkey.
authors.forename: Emsal
authors.initials: E
authors.lastname: Aydın
authors.affiliation: Military Hospital, Department of Infectious Diseases and Clinical Microbiology, Tatvan, Turkey.
authors.forename: Husrev
authors.initials: H
authors.lastname: Diktas
authors.affiliation: Tepecik Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Izmir, Turkey.
authors.forename: Sukran
authors.initials: S
authors.lastname: Kose
authors.affiliation: GATA Haydarpasa Training Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
authors.forename: Asim
authors.initials: A
authors.lastname: Ulcay
authors.affiliation: Antalya Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Antalya, Turkey.
authors.forename: Derya
authors.initials: D
authors.lastname: Seyman
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Sarikamis Military Hospital, Kars, Turkey.
authors.forename: Umit
authors.initials: U
authors.lastname: Savasci
authors.affiliation: Ondokuz Mayis University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Samsun, Turkey.
authors.forename: Hakan
authors.initials: H
authors.lastname: Leblebicioglu
authors.affiliation: Medeniyet University, Goztepe Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
authors.forename: Haluk
authors.initials: H
authors.lastname: Vahaboglu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002443:Ceftriaxone / Q000627:therapeutic use*; D002511:Cephalosporins / Q000627:therapeutic use*; D015331:Cohort Studies; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008586:Meningitis, Pneumococcal / Q000188:drug therapy* / Q000401:mortality; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D010403:Penicillin Resistance; D010406:Penicillins / Q000494:pharmacology; D012189:Retrospective Studies; D016896:Treatment Outcome; D014421:Turkey / Q000453:epidemiology; D014640:Vancomycin / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D010406:Penicillins; D014640:Vancomycin; D002443:Ceftriaxone
keywords: Meningitis; Mortality; Penicillin; Resistance; Streptococcus pneumoniae; Vancomycin