HOMEPRODUCTSCOMPANYCONTACTFAQResearchDictionaryPharmaSign Up FREE or Login

Prevention and treatment of penicillin-resistant Streptococcus pneumoniae meningitis after intracraniofacial surgery with distraction osteogenesis.

Abstract
The prevalence of penicillin-resistant Streptococcus pneumoniae (PRSP) meningitis has increased worldwide, particularly in East Asia and the United States. We recently experienced a case of PRSP meningitis that developed during frontofacial distraction. The patient was a 7-year-old girl with Crouzon disease who was treated by frontofacial monobloc/Le Fort IV minus glabellar osteotomy with quadruple internal distraction devices. Penicillin-resistant Streptococcus pneumoniae meningitis was diagnosed after surgery and treated successfully with meropenem (a carbapenem) at 120 mg kg d every 8 hours, ceftriaxone (a third-generation cephalosporin) at 100 mg kg d every 12 hours, and vancomycin (a glycopeptide) at 45 mg kg d every 6 hours. This case indicates that severe and fatal bacterial meningitis may occur as a postoperative complication due to multidrug-resistant bacteria indigenous to the nasal cavity after simultaneous osteotomy of the cranium and facial bone in intracraniofacial surgery, such as that for syndromic craniosynostosis and hypertelorbitism. In such cases, preventive strategies should include preoperative administration of pneumococcal vaccine, preoperative screening of nasal bacterial flora by nasal culture test, and prior administration of a carbapenem with good cerebrospinal fluid transfer or a third- or fourth-generation cephem covering PRSP. Postoperatively, suspected meningitis may be treated with a combination of the 3 drugs used in our case, in parallel with emergency cephalic contrast computed tomography and culture tests of blood and cerebrospinal fluid. Our experience suggests that these measures will facilitate a successful outcome in frontofacial distraction osteogenesis.
AuthorsYorikatsu Watanabe, Tanetaka Akizuki
JournalThe Journal of craniofacial surgery (J Craniofac Surg) Vol. 19 Issue 6 Pg. 1542-8 (Nov 2008) ISSN: 1536-3732 [Electronic] United States
PMID19098547 (Publication Type: Case Reports, Journal Article)
Chemical References
  • Anti-Bacterial Agents
  • Drug Combinations
  • Thienamycins
  • Vancomycin
  • Ceftriaxone
  • Meropenem
Topics
  • Anti-Bacterial Agents (administration & dosage)
  • Ceftriaxone (administration & dosage)
  • Child
  • Craniofacial Dysostosis (surgery)
  • Drug Combinations
  • Female
  • Follow-Up Studies
  • Frontal Bone (surgery)
  • Humans
  • Meningitis, Pneumococcal (drug therapy, prevention & control)
  • Meropenem
  • Osteogenesis, Distraction (adverse effects)
  • Osteotomy (adverse effects)
  • Osteotomy, Le Fort (adverse effects)
  • Penicillin Resistance
  • Streptococcus pneumoniae (drug effects)
  • Surgical Wound Infection (drug therapy, prevention & control)
  • Thienamycins (administration & dosage)
  • Tomography, X-Ray Computed
  • Treatment Outcome
  • Vancomycin (administration & dosage)

Join CureHunter, for free Research Interface BASIC access!

Take advantage of free CureHunter research engine access to explore the best drug and treatment options for any disease. Find out why thousands of doctors, pharma researchers and patient activists around the world use CureHunter every day.
Realize the full power of the drug-disease research graph!


Choose Username:
Email:
Password:
Verify Password:
Enter Code Shown: