Penicillin-resistant pneumococcal meningitis in an immunocompromised infant

Mace, John; Janik, Daniel S.; Sauer, Ronald L.; Quilligan, J. J.

doi:10.1016/s0022-3476(77)81339-5

Cited by 27 publications

(13 citation statements)

References 3 publications

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“…In a recent study, Henderson and co-workers (113) 3,1990 The 8 to 19% carriage of resistant strains in the community, e.g., in South Africa, supports the idea that resistant strains have become part of the resident microflora of large numbers of children; since carriage of resistant pneumococci was common even in rural areas, where exposure to antibiotics would be less likely (147), these resistant strains probably colonize children in direct competition with susceptible strains even in the absence of antibiotic pressure (144) (7) or immune deficiency (3,107,174,200,207) led to a hypothesis that cell wall changes in resistant pneumococci may alter their ability to stimulate the alternate complement pathway and give these strains a selective advantage in immunodeficient individuals (207). There is, however, no current evidence to support this hypothesis.…”

Section: Hospitalizationmentioning

confidence: 70%

“…Numerous studies and case reports have documented the poor response to penicillin therapy of patients with meningitis caused by intermediately penicillin-resistant pneumococci (3,7,44,84,121,125,200,211,219,228), although some patients have responded to increased doses of penicillin (135,174,200). A review of the reported cases to 1980 (273) showed that 2 of 12 patients with meningitis caused by relatively resistant strains responded to penicillin, compared with none of 9 responses to penicillin in patients infected with strains for which penicillin MICs were .2.0 mg/liter.…”

Section: Meningitismentioning

confidence: 99%

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Pneumococcal resistance to antibiotics

1990

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The geographic distribution of pneumococci resistant to one or more of the antibiotics penicillin, erythromycin, trimethoprim-sulfamethoxazole, and tetracycline appears to be expanding, and there exist foci of resistance to chloramphenicol and rifampin. Multiply resistant pneumococci are being encountered more commonly and are more often community acquired. Factors associated with infection caused by resistant pneumococci include young age, duration of hospitalization, infection with a pneumococcus of serogroup 6, 19, or 23 or serotype 14, and exposure to antibiotics to which the strain is resistant. At present, the most useful drugs for the management of resistant pneumococcal infections are cefotaxime, ceftriaxone, vancomycin, and rifampin. If the strains are susceptible, chloramphenicol may be useful as an alternative, less expensive agent. Appropriate interventions for the control of resistant pneumococcal outbreaks include investigation of the prevalence of resistant strains, isolation of patients, possible treatment of carriers, and reduction of usage of antibiotics to which the strain is resistant. The molecular mechanisms of penicillin resistance are related to the structure and function of penicillin-binding proteins, and the mechanisms of resistance to other agents involved in multiple resistance are being elucidated. Recognition is increasing of the standard screening procedure for penicillin resistance, using a 1-microgram oxacillin disk.

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Section: Hospitalizationmentioning

confidence: 70%

Section: Meningitismentioning

confidence: 99%

Pneumococcal resistance to antibiotics

1990

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“…Numerous case reports of penicillin treatment failure in pneumococcal meningitis in children and adults have been published (1,3,8,10,11,20,21,24,25,39,44,48,53,63). In some patients a larger dosage of penicillin or treatment with chloramphenicol was effective.…”

Section: Therapy For Meningitis: Clinical Experience and Animal Studiesmentioning

confidence: 99%

Management of meningitis caused by penicillin-resistant Streptococcus pneumoniae

Paris

Ramilo

McCracken

1995

Antimicrob Agents Chemother

124

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Since the isolation of the first penicillin-resistant Streptococcus pneumoniae strain in 1967 (23), there have been many reports of treatment failure in patients with pneumococcal infections caused by strains resistant to penicillin and other antimicrobial agents such as chloramphenicol, macrolides, trimethoprim-sulfamethoxazole, and the cephalosporins. As a result, the selection of antimicrobial agents for the treatment of infections caused by these organisms has become increasingly difficult. In particular, the emergence of pneumococci resistant to broad-spectrum cephalosporins has limited the choices of antibiotics for the treatment of pneumococcal meningitis. This minireview focuses on the specific problems encountered in managing patients with penicillin-and cephalosporin-resistant pneumococcal meningitis and discusses some therapeutic alternatives that have recently been explored.

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“…AGENTS CHEMOTHER. PBP 2 groi has been reported in a number (10,11,16,18,23 electrophoretic mobility, may be observed in strains of higher resistance levels (MIC ' 0.25 of clinical surveys ,ug/ml). If one arranges the resistant strains in ies described here the order of increasing MIC values, one has the to understand the impression that the alterations in PBPs represet of pneumococ-sent gradual and cumulative changes: the dedren at the Okla-creased penicillin affinities of PBP 2 evident lospital.…”

mentioning

confidence: 91%

Multiple changes of penicillin-binding proteins in penicillin-resistant clinical isolates of Streptococcus pneumoniae

Hakenbeck¹,

Tarpay²,

Tomasz³

1980

Antimicrob Agents Chemother

214

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Penicillin-binding properties and characteristics of penicillin-binding proteins (PBPs) were investigated in several clinical isolates of Streptococcus pneumoniae differing in their susceptibilities to penicillin (minimal inhibitory concentration [MIC], 0.03 to 0.5 jig/ml) and compared with the penicillin-susceptible strain R36A (MIC, 0.07 ,ug/ml). Several changes accompanied the development of resistance: the relative affinity to penicillin of whole cells, isolated membranes, and two major PBPs after in vivo or in vitro labeling decreased (with increasing resistance). Furthermore, one additional PBP (2') appeared in four of five relatively resistant strains with an MIC of 0.25 ,ug/ml and higher. PBP 3 maintained the same high affinity toward penicillin in all strains under all labeling conditions.

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Penicillin-resistant pneumococcal meningitis in an immunocompromised infant

Cited by 27 publications

References 3 publications

Pneumococcal resistance to antibiotics

Pneumococcal resistance to antibiotics

Management of meningitis caused by penicillin-resistant Streptococcus pneumoniae

Multiple changes of penicillin-binding proteins in penicillin-resistant clinical isolates of Streptococcus pneumoniae

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