Therapy and outcomes of meningitis caused by drug-resistant Streptococcus pneumoniae (SP) in three U.S. cities, 1994-1996

J. Moroney, A. Fiore, M. Parley, L. Harrison, J. Patterson, M. Cetron, A. Schuchat

Research output: Contribution to journalArticle

Abstract

Limited data are available on the clinical impact of penicillin nonsusceptible SP (PNSSP) infections. We identified all SP meningitis cases in Atlanta (n=44), Baltimore (n-26), and San Antonio (n=15) through population-based, active surveillance from 11/94 to 4/96, and abstracted data from hospital charts. Meningitis was caused by SP resistant (R) and intermediate (I) to penicillin in 19 (22%) and 14 (16%) cases, respectively; cefotaxime R and I strains each caused 10 (12%) cases. PNSSP (I+R) patients varied by age (<18 years, 47%; 18-64 years, 29%; 65+years, 46%). Mortality rates also varied by age (<18 years, 3%; 18-64 years, 29%; 65+ years, 8%; p=0.006). Persons 18-64 years accounted for 45% of meningitis cases and 85% (11/13) of deaths. Most adult patients (69%) had ≥1 underlying illness; asplenia (20%), HIV infection (18%), and diabetes (18%) were most common. Overall, patients with underlying illness (other than HIV) were more likely to die (21% vs. 11%; p=0.19) but had similar rates of admission to ICU (54% vs. 61%). Vancomycin was used empirically within 48 hrs of hospital admission in 59% of cases. Only two persons had SP infection that was R to all antimicrobial agents administered empirically. The rate of empiric vancomycin use by city varied (38%-75%) in parallel with differing rates of PNSSP. Rates of vancomycin use were higher among patients admitted to ICU (67% vs. 47%; p=0.06). Although PNSSP was associated with admission to ICU among persons 18-64 years (RR 1.5, 95% CI 1.0-2.4), the association did not hold for other age groups. PNSSP was not associated with mortality in any age group. Clinical outcomes of meningitis are influenced by age and underlying illness. Use of vancomycin in the empiric treatment of bacterial meningitis may lead to clinical outcomes for PNSSP similar to those observed for susceptible SP when empiric therapy excludes vancomycin.

Original languageEnglish (US)
Number of pages1
JournalClinical Infectious Diseases
Volume25
Issue number2
StatePublished - Dec 1 1997
Externally publishedYes

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

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