PDF(Pubmed)
Abstract：
To report on the therapy used for penicillin- and cephalosporin-resistant pneumococcal meningitis, we conducted an observational cohort study of patients admitted to our hospital with pneumococcal meningitis between 1977 and 2018. According to the European Committee on Antimicrobial Susceptibility Testing (EUCAST) recommendations, we defined pneumococci as susceptible and resistant to penicillin with MIC values of ≤0.06 mg/L and > 0.06 mg/L, respectively; the corresponding values for cefotaxime (CTX) were ≤0.5 mg/L and >0.5 mg/L. We treated 363 episodes of pneumococcal meningitis during the study period. Of these, 24 had no viable strain, leaving 339 episodes with a known MIC for inclusion. Penicillin-susceptible strains accounted for 246 episodes (73%), penicillin-resistant strains for 93 (27%), CTX susceptible for 58, and CTX resistant for 35. Nine patients failed or relapsed and 69 died (20%), of whom 22% were among susceptible cases and 17% were among resistant cases. During the dexamethasone period, mortality was equal (12%) in both susceptible and resistant cases. High-dose CTX (300 mg/Kg/day) helped to treat failed or relapsed cases and protected against failure when used as empirical therapy (P = 0.02), even in CTX-resistant cases. High-dose CTX is a good empirical therapy option for pneumococcal meningitis in the presence of a high prevalence of penicillin and cephalosporin resistance, effectively treating pneumococcal strains with MICs up to 2 mg/L for either penicillin or CTX.
摘要：
报告青霉素和头孢菌素耐药的肺炎球菌脑膜炎的治疗方法，我们对我院1977~2018年收治的肺炎球菌性脑膜炎患者进行了一项观察性队列研究.根据欧洲抗菌药物敏感性试验委员会（EUCAST）的建议，我们将肺炎球菌定义为对青霉素敏感和耐药，MIC值≤0.06mg/L和>0.06mg/L，头孢噻肟（CTX）的相应值分别为≤0.5mg/L和>0.5mg/L。在研究期间，我们治疗了363次肺炎球菌性脑膜炎。其中,24没有存活菌株，留下339集，并包含已知的MIC。青霉素敏感株占246例(73%)，耐青霉素菌株93株（27%），CTX易感58，而CTX耐药35。9例患者失败或复发，69例死亡（20％），其中22%为易感病例，17%为耐药病例。在地塞米松期间，易感和耐药病例的死亡率相等(12%).高剂量CTX（300mg/Kg/天）有助于治疗失败或复发的病例，并在用作经验疗法时防止失败（P=0.02），即使在CTX耐药的病例中。在青霉素和头孢菌素耐药性高发的情况下，高剂量CTX是肺炎球菌性脑膜炎的良好经验性治疗选择。对于青霉素或CTX，MIC高达2mg/L的肺炎球菌菌株有效治疗。
