Imipenem-Cilastatin Therapy in a Child With Meningitis Caused by a Multiply Resistant Pneumococcus

The most appropriate therapy for meningitis caused by Streptococcus pneumoniae strains resistant to the extended-spectrum cephalosporins is unknown. We evaluated ceftriaxone, vancomycin, and rifampin alone and in different combinations and meropenem, cefpirome, and clinafloxacin alone in the rabbit meningitis model. Meningitis was induced in rabbits by intracisternal inoculation of one of two pneumococcal strains isolated from infants with meningitis (ceftriaxone MICs, 4 and 1 ,g/ml, respectively). Two doses, 5 h apart, of each antibiotic were given intravenously (except that ceftriaxone was given as one dose). Cerebrospinal fluid bacterial concentrations were measured at 0, 5, 10, and 24 h after therapy was started. Clinafloxacin was the most active single agent against both strains. Against the more resistant strain, ceftriaxone or meropenem alone was ineffective. The combination of vancomycin and ceftriaxone was synergistic, suggesting that this combination might be effective for initial empiric therapy of pneumococcal meningitis until results of susceptibility studies are available.

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“…CSF bacterial concentrations in each rabbit treatment group infected with strain 1 are shown in Fig. 2 (1,3,5,10,20).…”

Section: Resultsmentioning

confidence: 99%

Evaluation of antimicrobial regimens for treatment of experimental penicillin- and cephalosporin-resistant pneumococcal meningitis

Friedland

Paris

Ehrett

et al. 1993

Antimicrob Agents Chemother

222

118

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“…Although optimal therapy for penicillin-resistant pneumococcal meningitis has yet to be defined, extended-spectrum cephalosporins have been recommended for most cases. However, treatment failures with broad-spectrum cephalosporins in meningitis caused by penicillin-resistant pneumococci have been reported in Spain and the United States (1,3,4,6,19,28). Erythromycin resistance increased dramatically from 0% in 1983 to 42.4% in 1993 and 39.2% by this study.…”

Section: Discussionmentioning

confidence: 99%

Emergence of multiple-antibiotic-resistant Streptococcus pneumoniae in Hong Kong

Kam

Luey

Fung

et al. 1995

Antimicrob Agents Chemother

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Two hundred four strains of Streptococcus pneumoniae isolated in Hong Kong from January 1993 to May 1995 were analyzed for their antibiotic susceptibilities and epidemiological patterns. The ages of the patients from whom the strains were isolated ranged from 1 month to 93 years (median, 53 years); the male-to-female ratio was 2.8, with a predominance of males in the pediatric group. Fifty-nine (28.9%) strains showed reduced penicillin susceptibility, including 40 (19.6%) with frank penicillin resistance (MIC > 1 g/ml). Tetracycline resistance alone was found in 28.4% of strains. Isolates with reduced penicillin susceptibility were more common in children than adults (40 versus 23.9%; P ‫؍‬ 0.02), and penicillin resistance rates were significantly higher in hospitalized patients than in outpatients (39.5 versus 12.5%; P < 0.001). Penicillin resistance was significantly associated with resistance to ceftriaxone, erythromycin, and tetracycline (P < 0.01) but not with ofloxacin or vancomycin (P ‫؍‬ 0.5). Among eight different patterns of resistance to three or more antibiotics, the commonest one (14.2%) was multiple resistance to penicillin, chloramphenicol, ceftriaxone, erythromycin, and tetracycline. Emergence of multiple-antibiotic-resistant S. pneumoniae reflects recent changes in the pneumococcus itself and the general indiscriminate use of antibiotics in treatment of respiratory infections in Hong Kong.Despite the prompt use of antibiotic treatment, the pneumococci persist as a significant cause of morbidity and mortality in humans (5,7,8,30,31). The number of pneumococcal strains found to be resistant to different antimicrobial drugs is increasing worldwide (2). In the Southeast Asian region, the recent report of a penicillin resistance rate of 70% in Korea was one of the highest reported to date (15,17). In Hong Kong, earlier case reports have indicated the possible spread of penicillin-resistant pneumococci in the community (29). Prompted by an earlier pilot study (18), we embarked on a comprehensive survey to assess the extent of the problem. We describe here the results of our study on the antibiotic susceptibilities and epidemiology of the multiple-antibiotic-resistant pneumococci in Hong Kong. MATERIALS AND METHODSBacterial strains. Strains of Streptococcus pneumoniae were collected from four public hospital and two outpatient clinic laboratories from January 1993 to May 1995. These laboratories were scattered over most urban districts of Hong Kong. Isolates were transported in screw-cap bottles with cooked-meat medium and subcultured on 5% horse blood agar plates with 5% CO 2 on arrival. Identification was performed by colonial morphology on blood agar, Gram stain, optochin susceptibility, bile solubility, and API 20S tests (bioMerieux, Marcy l'Etoile, France). After identity was confirmed, strains were lyophilized and stored at room temperature before further examination.Antibiotic susceptibility tests. The broth microdilution method as described by the National Committee for Clinical Laboratory Stan...

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“…MIC breakpoints for interpreting tests with penicillin were those described by others (8,10,13,14). For tests of cefotaxime, strains for which the MIC was Ն2.0 g/ml were assumed to be resistant because such isolates have been involved in the clinical failures that have been reported previously (1,(3)(4)(5)(6)(7)(8)16). Jacobs et al (9) recently attempted to define the predictive value of different cefotaxime MIC categories.…”

Section: Methodsmentioning

confidence: 99%

In vitro activities of cefotaxime, ceftriaxone, ceftazidime, cefpirome, and penicillin against Streptococcus pneumoniae isolates

Barry¹,

Brown²,

Novick³

1995

Antimicrob Agents Chemother

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The in vitro activities of four extended-spectrum cephalosporins and benzyl penicillin were evaluated against 698 clinical isolates of Streptococcus pneumoniae, including 130 (19%) penicillin-intermediate and 84 (12%) penicillin-resistant strains. Cefotaxime and ceftriaxone were essentially identical in their antipneumococcal activities: both were active against penicillin-susceptible strains and most penicillin-intermediate strains.Cefpirome was twice as potent as cefotaxime and ceftriaxone against penicillin-resistant strains. Ceftazidime was 8-to 16-fold less active than cefotaxime and ceftriaxone against S. pneumoniae in vitro, and thus, its spectrum included only penicillin-susceptible strains.

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Imipenem-Cilastatin Therapy in a Child With Meningitis Caused by a Multiply Resistant Pneumococcus

Cited by 63 publications

References 0 publications

Evaluation of antimicrobial regimens for treatment of experimental penicillin- and cephalosporin-resistant pneumococcal meningitis

Evaluation of antimicrobial regimens for treatment of experimental penicillin- and cephalosporin-resistant pneumococcal meningitis

Emergence of multiple-antibiotic-resistant Streptococcus pneumoniae in Hong Kong

In vitro activities of cefotaxime, ceftriaxone, ceftazidime, cefpirome, and penicillin against Streptococcus pneumoniae isolates

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