Relapsing pneumococcal meningitis: Isolation of an organism with decreased susceptibility to penicillin G

Naraqi, S; Kirkpatrick, Garland P.; Kabins, Sherwin A.

doi:10.1016/s0022-3476(74)80513-5

Cited by 138 publications

(43 citation statements)

References 8 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%

“…The clinical relevance of intermediate resistance to the management of meningitis and the potential importance of the distinction between intermediate and high-level resistance in the management of all pneumococcal infections demand the retention of the two subdivisions of penicillin-resistant strains. The terms intermediately resistant for pneumococci for which penicillin MICs are between 0.1 and 1.0 mg/liter inclusively and highly resistant for strains for which the MIC is .2 mg/liter may be desir- 407,1985), "increased resistance" (57,211), "moderately resistant" (84), "relatively insensitive" (108), "reduced susceptibility" (137), "decreased susceptibility" (200), "decreased sensitivity" (199), and "intermediate resistance" (275). While the choice of a name is arbitrary, the terms intermediately and highly resistant fit the biochemical and genetic concepts of a stepwise increase in penicillin resistance (238,259,283) and accommodate the concept of low-level resistance, shown also to correlate with changes in affinity of penicillin-binding proteins (103; L. McDougal and C. Thornsberry, 29th ICAAC, abstr.…”

Section: Note On Nomenclature and Criteria Of Resistancementioning

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: Note On Nomenclature and Criteria Of Resistancementioning

confidence: 99%

Pneumococcal resistance to antibiotics

1990

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“…Given the wide intermediate range for penicillin (0.1 to 1.0 g/ml), it is very difficult to devise a disk diffusion test using a 2-U or 10-U penicillin disk that accurately differentiates susceptible and resistant isolates. Because the breakpoint of 0.1 g/ml is so important for optimal therapy of pneumococcal meningitis (19,24,31,56) and because highlevel ceftriaxone-and cefotaxime-resistant pneumococci have emerged (45), the importance of using accurate MIC methods for penicillin and extended-spectrum cephalosporins cannot be overstated. Although the Etest method has been shown to be an accurate predictor of penicillin and cephalosporin resistance (29), it is often too expensive for widespread use in developing countries.…”

Section: Discussionmentioning

confidence: 99%

Ability of Laboratories To Detect Emerging Antimicrobial Resistance: Proficiency Testing and Quality Control Results from the World Health Organization's External Quality Assurance System for Antimicrobial Susceptibility Testing

Tenover¹,

Mohammed²,

Stelling

et al. 2001

J Clin Microbiol

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The accuracy of antimicrobial susceptibility data submitted by microbiology laboratories to national and international surveillance systems has been debated for a number of years. To assess the accuracy of data submitted to the World Health Organization by users of the WHONET software, the Centers for Disease Control and Prevention distributed six bacterial isolates representing key antimicrobial-resistance phenotypes to approximately 130 laboratories, all but one of which were outside of the United States, for antimicrobial susceptibility testing as part of the World Health Organization's External Quality Assurance System for Antimicrobial Susceptibility Testing. Each laboratory also was asked to submit 10 consecutive quality control values for several key organism-drug combinations. Most laboratories were able to detect methicillin (oxacillin) resistance in Staphylococcus aureus, high-level vancomycin resistance in Enterococcus faecium, and resistance to extended-spectrum cephalosporins in Klebsiella pneumoniae. Many laboratories, particularly those using disk diffusion tests, had difficulty in recognizing reduced susceptibility to penicillin in an isolate of Streptococcus pneumoniae. The most difficult phenotype for laboratories to detect was reduced susceptibility to vancomycin in an isolate of Staphylococcus epidermidis. The proficiency testing challenge also included a request for biochemical identification of a gram-negative bacillus, which most laboratories recognized as Enterobacter cloacae. Although only a small subset of laboratories have submitted their quality control data, it is clear that many of these laboratories generate disk diffusion results for oxacillin when testing S. aureus ATCC 25923 and S. pneumoniae ATCC 49619 that are outside of the acceptable quality control range. The narrow quality control range for vancomycin also proved to be a challenge for many of the laboratories submitting data; approximately 27% of results were out of range. Thus, it is important to establish the proficiency of laboratories submitting data to surveillance systems in which the organisms are tested locally, particularly for penicillin resistance in pneumococci and glycopeptide resistance in staphylococci.Resistance to a variety of antimicrobial agents is emerging in bacterial pathogens throughout the world (8,21,50). Increases in the prevalence of penicillin resistance in Streptococcus pneumoniae (13,36,39,47), methicillin resistance in Staphylococcus aureus (1, 3, 38), vancomycin resistance in enterococci (5, 9, 16, 28), extended-spectrum ␤-lactamase-production in enteric gram-negative bacilli (2, 18, 37), and fluoroquinolone resistance in Neisseria gonorrhoeae (17) are just a few examples of the rising problem of resistance documented by both national and international surveillance systems in the past few years. The antimicrobial susceptibility testing data collected by the various surveillance systems are generated in several different fashions. In some systems, bacterial isolates are sent to a central labo...

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“…Although significant infections with pneumococcal strains fully resistant to penicillin are comparatively rare throughout the world, serious diseases caused by RPR are associated with high mortality and morbidity [23][24][25]. The clinical significance of RPR cannot be overemphasized especially in cases involving pneumococcal meningitis, septicemia or other serious infections.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, pneumococcal meningitis caused by RPR to penicillin may not respond to penicillin therapy. Indeed, all reports of relapses or prolonged illness have been in patients with meningitis [23][24][25].…”

Section: Discussionmentioning

confidence: 99%