Is adjunctive corticosteroid beneficial in pneumococcal meningitis in a region with high rates of resistance to penicillin and ceftriaxone?

Abstract

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.

• Authors: Soo-Youn Moon, Doo Ryeon Chung, Shin-Woo Kim, Hyun Ha Chang, Hyuck Lee, Dong Sik Jung, Yeon-Sook Kim, Sook In Jung, Seong Yeol Ryu, Sang Taek Heo, Chisook Moon, Hyun Kyun Ki, Jun Seong Son, Ki Tae Kwon, Sang Yop Shin, Jin Seo Lee, Seung Soon Lee, Ji-Young Rhee, Cheol-In Kang, Kyong Ran Peck, Jae-Hoon Song
• Journal: Journal of neurology (J Neurol) Vol. 259 Issue 7 Pg. 1453-60 (Jul 2012) ISSN: 1432-1459 [Electronic] Germany
• PMID: 22222857 (Publication Type: Journal Article, Multicenter Study)

Chemical References

• Adrenal Cortex Hormones
• Anti-Bacterial Agents
• Penicillins
• Ceftriaxone

Topics

• Adrenal Cortex Hormones (therapeutic use)
• Adult
• Aged
• Anti-Bacterial Agents (adverse effects)
• Ceftriaxone (adverse effects)
• Cohort Studies
• Female
• Humans
• Kaplan-Meier Estimate
• Male
• Meningitis, Pneumococcal (drug therapy, microbiology, mortality)
• Middle Aged
• Penicillin Resistance (drug effects)
• Penicillins (adverse effects)
• Retrospective Studies
• Streptococcus pneumoniae (pathogenicity)
• Survival Rate
• Time Factors
• Treatment Outcome