Severe community-acquired Streptococcus pneumoniae bacterial meningitis: clinical and prognostic picture from the intensive care unit

Abstract

Background Severe community-acquired pneumococcal meningitis is a medical emergency. The aim of the present investigation was to evaluate the epidemiology, management and outcomes of this condition. Methods This was a retrospective, observational and multicenter cohort study. Sixteen Spanish intensive care units (ICUs) were included. Demographic, clinical and microbiological variables from patients with Streptococcus pneumoniae meningitis admitted to ICU were evaluated. Clinical response was evaluated at 72 h after antibiotic treatment initiation, and meningitis complications, length of stay and 30-day mortality were also recorded. Results In total, 255 patients were included. Cerebrospinal fluid (CSF) culture was positive in 89.7%; 25.7% were non-susceptible to penicillin, and 5.2% were non-susceptible to ceftriaxone or cefotaxime. The most frequent empiric antibiotic regimen was third-generation cephalosporin (47.5%) plus vancomycin (27.8%) or linezolid (12.9%). A steroid treatment regimen was administered to 88.6% of the patients. Clinical response was achieved in 65.8% of patients after 72 h of antibiotic treatment. Multivariate analysis identified two factors associated with early treatment failure: invasive mechanical ventilation (OR 10.74; 95% CI 3.04–37.95, p < 0.001) and septic shock (OR 1.18; 95% CI 1.03–1.36, p = 0.017). The 30-day mortality rate was 13.7%. Only three factors were independently associated with 30-day mortality: delay in start of antibiotic treatment (OR 18.69; 95% CI 2.13–163.97, p = 0.008), Sepsis-related Organ Failure Assessment (SOFA) score (OR 1.36; 95% CI 1.12–1.66, p = 0.002) and early treatment failure (OR 21.75 (3.40–139.18), p = 0.001). Neurological complications appeared in 124 patients (48.63%). Conclusions Mortality rate in critically ill patients with pneumococcal meningitis is lower than previously reported. Delay in antibiotic treatment following admission is the only amendable factor associated with mortality.

Prevalence of Penicillin Resistance Among Streptococcus pneumoniae Isolates in a General Hospital in Southwest Saudi Arabia: A Five-Year Retrospective Study

“…Furthermore, even with treatment, complete recovery may not be achievable [ 27 ]. These findings underscore the potential seriousness of S. pneumoniae infection when it invades the meninges, particularly in cases where there is a delay in initiating appropriate antibiotic therapy or selecting the right antibiotic empirically [ 28 ]. However, as stated earlier, this study was conducted in vitro and did not directly observe associated complications or complete recovery.…”

Protective effect and mechanism of nanoantimicrobial peptide ND-C14 against Streptococcus pneumoniae infection

“…[19] In clinical treatment, β-lactam antibiotics and vancomycin are commonly used antibiotics to treat S. pneumoniae infection. [21] However, strains of S. pneumoniae resistant to penicillin, fluoroquinolones, macrolides, trimethoprim and vancomycin have now spread globally. [22,23] Therefore, the development of new antibiotics is essential to address the threat of resistance in S. pneumoniae.…”

Bacterial Infections in Intensive Care Units: Epidemiological and Microbiological Aspects

“…Although the possible ICU patient enters with S. pneumoniae meningitis, some patients reach the same units for different acute conditions, developing S. pneumoniae meningitis, bacteriemia, or pneumoniae after an upper tract colonization (nasopharynx) by the same species. The S. pneumoniae capability to cause severe infection depends on the host’s immune conditions and the bacterial virulence pattern [ 72 ]. The microorganisms produce a polysaccharide capsule, surface proteins, and the toxin pneumolysin.…”