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: Hakan Erdem, Nazif Elaldi, Nefise Öztoprak, Gonul Sengoz, Oznur Ak, Selcuk Kaya, Asuman Inan, Saygın Nayman-Alpat, Ayşegül Ulu-Kilic, Abdullah Umut Pekok, Alper Gunduz, Mustafa G Gozel, Filiz Pehlivanoglu, Kadriye Yasar, Hava Yılmaz, Mustafa Hatipoglu, Gonul Cicek-Senturk, Fusun Z Akcam, Ahmet C Inkaya, Esra Kazak, Ayşe Sagmak-Tartar, Recep Tekin, Derya Ozturk-Engin, Yasemin Ersoy, Oguz Resat Sipahi, Tumer Guven, Gunay Tuncer-Ertem, Selma Alabay, Ayhan Akbulut, Ilker I Balkan, Oral Oncul, Birsen Cetin, Saim Dayan, Gulden Ersoz, Ahmet Karakas, Nail Ozgunes, Alper Sener, Aysegul Yesilkaya, Ayse Erturk, Sibel Gundes, Oguz Karabay, Fatma Sirmatel, Selma Tosun, Vedat Turhan, Aysun Yalci, Yasemin Akkoyunlu, Emsal Aydın, Husrev Diktas, Sukran Kose, Asim Ulcay, Derya Seyman, Umit Savasci, Hakan Leblebicioglu, Haluk Vahaboglu
• Journal: International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases (Int J Infect Dis) Vol. 19 Pg. 13-9 (Feb 2014) ISSN: 1878-3511 [Electronic] Canada
• PMID: 24211227 (Publication Type: Journal Article, Multicenter Study)
• Copyright: Copyright © 2013 The Authors. Published by Elsevier Ltd.. All rights reserved.

Chemical References

• Anti-Bacterial Agents
• Cephalosporins
• Penicillins
• Vancomycin
• Ceftriaxone

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Anti-Bacterial Agents (therapeutic use)
• Ceftriaxone (therapeutic use)
• Cephalosporins (therapeutic use)
• Cohort Studies
• Drug Therapy, Combination
• Female
• Humans
• Male
• Meningitis, Pneumococcal (drug therapy, mortality)
• Microbial Sensitivity Tests
• Middle Aged
• Penicillin Resistance
• Penicillins (pharmacology)
• Retrospective Studies
• Treatment Outcome
• Turkey (epidemiology)
• Vancomycin (therapeutic use)
• Young Adult