Please use this identifier to cite or link to this item: https://www.arca.fiocruz.br/handle/icict/5857
Title: Clinical outcome of pneumococcal meningitis during the emergence of pencillin-resistant Streptococcus pneumoniae: an observational study.
Authors: Gouveia, Edilane Lins
Reis, Joice Neves
Flannery, Brendan
Cordeiro, Soraia Machado
Lima, Josilene Borges T
Pinheiro, Ricardo M
Salgado, Kátia M
Mascarenhas, Ana Veronica
Carvalho, Maria da Gloria S
Beall, Bernard W
Reis, Mitermayer Galvão dos
Ko, Albert Icksang
Affilliation: Fundação Oswaldo Cruz. Centro de Pesquisas Gonçalo Moniz. Salvador, Bahia, Brasil
Fundação Oswaldo Cruz. Centro de Pesquisas Gonçalo Moniz. Salvador, Bahia, Brasil
Pan American Health Organization. Brasilia, Brasil
Fundação Oswaldo Cruz. Centro de Pesquisas Gonçalo Moniz. Salvador, Bahia, Brasil
Fundação Oswaldo Cruz. Centro de Pesquisas Gonçalo Moniz. Salvador, Bahia, Brasil
Fundação Oswaldo Cruz. Centro de Pesquisas Gonçalo Moniz. Salvador, Bahia, Brasil
Secretary of Health for the State. Hospital Couto Maia. Salvador, Bahia, Brasil
Secretary of Health for the State. Hospital Couto Maia. Salvador, Bahia, Brasil
Centers for Disease Control and Prevention. Streptococcus Laboratory. Atlanta, Georgia, USA
Centers for Disease Control and Prevention. Streptococcus Laboratory. Atlanta, Georgia, USA
Fundação Oswaldo Cruz. Centro de Pesquisas Gonçalo Moniz. Salvador, Bahia, Brasil
Fundação Oswaldo Cruz. Centro de Pesquisas Gonçalo Moniz. Salvador, Bahia, Brasil
Abstract: Prior to the availability of generic third-generation cephalosporins, penicillins were widely used for treatment of pneumococcal meningitis in developing countries despite concerns about rising levels of penicillin resistance among pneumococcal isolates. We examined the impact of penicillin resistance on outcomes of pneumococcal meningitis over a ten year period in an infectious diseases hospital in Brazil. METHODS: Clinical presentation, antimicrobial therapy and outcomes were reviewed for 548 patients with culture-confirmed pneumococcal meningitis from December, 1995, to November, 2005. Pneumococcal isolates from meningitis patients were defined as penicillin-resistant if Minimum Inhibitory Concentrations for penicillin were greater than 0.06 µg/ml. Proportional hazards regression was used to identify risk factors for fatal outcomes. RESULTS: During the ten-year period, ceftriaxone replaced ampicillin as first-line therapy for suspected bacterial meningitis. In hospital case-fatality for pneumococcal meningitis was 37%. Of 548 pneumococcal isolates from meningitis cases, 92 (17%) were resistant to penicillin. After controlling for age and severity of disease at admission, penicillin resistance was associated with higher case-fatality (Hazard Ratio [HR], 1.62; 95% Confidence Interval [CI], 1.08-2.43). Penicillin-resistance remained associated with higher case-fatality when initial therapy included ceftriaxone (HR, 1.68; 95% CI 1.02-2.76). CONCLUSIONS: Findings support the use of third generation cephalosporin antibiotics for treatment of suspected pneumococcal meningitis even at low prevalence of pneumococcal resistance to penicillins.
DeCS: Antibacterianos/administração & dosagem
Meningite Pneumocócica/quimioterapia
Meningite Pneumocócica/microbiologia
Resistência às Penicilinas
Streptococcus pneumoniae/efeitos de drogas
beta-Lactamas/administração & dosagem
Adulto
Adolescente
Idoso
Idoso de 80 Anos ou mais
Brasil
Criança
Pré-Escolar
Feminino
Hospitais
Humanos
Lactente
Recém-Nascido
Masculino
Meningite Pneumocócica/mortalidade
Testes de Sensibilidade Microbiana
Meia-Idade
Resultado de Tratamento
Adulto Jovem
Issue Date: 2011
Citation: GOUVEIA, E.L. et al. Clinical outcome of pneumococcal meningitis during the emergence of pencillin-resistant Streptococcus pneumoniae: an observational study. BMC Infectious Diseases, v. 11, p. 323, 2011.
DOI: 10.1186/1471-2334-11-323
ISSN: 1471-2334
Appears in Collections:IGM - Artigos de Periódicos

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