背景:对青霉素耐药的肺炎链球菌(PRSP)患者的治疗是复杂的,因为有效抗菌药物的血脑屏障渗透相对较差。我们的案例:一个以前健康的70岁女性,一个从中国到日本的旅行者,因发烧和失去知觉入院.她没有肺炎球菌疫苗接种史。由于肺炎链球菌的青霉素和第三代头孢菌素耐药菌株,她被诊断出患有细菌性脑膜炎。该患者成功接受了万古霉素(VCM)和左氧氟沙星(LVFX)的联合治疗,并康复,没有任何神经系统后遗症。由于肺炎链球菌脑膜炎的青霉素和第三代头孢菌素耐药菌株的治疗仍不清楚,我们对报道的由青霉素和头孢菌素耐药的肺炎链球菌引起的脑膜炎病例进行了回顾.
方法:我们使用关键字\"耐青霉素肺炎链球菌,脑膜炎,\"和\"肺炎球菌性脑膜炎\"。我们搜索了PubMed的电子数据库,Embase,和Ichushi从成立到2020年3月。随后,两位作者独立审查了由此产生的数据库记录,检索到资格评估全文,并从这些案例中提取数据。
结果:我们确定了18篇论文,描述了35例青霉素和头孢菌素耐药的肺炎链球菌脑膜炎,包括我们的病例。患者的特征是,中位年龄:50岁,男性:50%,85%的病例接受了抗生素联合治疗方案:头孢曲松(CTRX)加VCM(20例),CTRX加VCM加利福平(RFP)(2例),CTRX加利奈唑胺(一例),氟喹诺酮类药物(2例),碳青霉烯类(6例),35%的人接受了类固醇治疗。24%的患者死亡。26%的患者并发神经系统后遗症。
结论:包括VCM加LVFX在内的联合治疗可能是一种治疗选择。
BACKGROUND: Treatment of patients with penicillin-resistant S. pneumoniae (PRSP) is complicated because of the relatively poor blood-brain barrier penetration of effective antimicrobials. Our
case: A previously healthy 70-year-old woman, a traveler from China to Japan, was admitted to our hospital with fever and loss of consciousness. She has no history of pneumococcal vaccination. She was diagnosed with bacterial meningitis due to penicillin-and third-generation cephalosporin-resistant strains of S. pneumoniae. The patient was successfully treated with a combination therapy of vancomycin (VCM) and levofloxacin (LVFX) and recovered without any neurological sequelae. As the treatment of penicillin-and third-generation cephalosporin-resistant strains of S. pneumoniae meningitis remains unclear, we conducted a review of the reported cases of meningitis caused by penicillin- and cephalosporin-resistant S. pneumoniae.
METHODS: We performed a search using the keywords \"penicillin-resistant Streptococcus pneumoniae,\" \"meningitis,\" and \"pneumococcal meningitis\". We searched the electronic databases PubMed, Embase, and Ichushi from their inception to March 2020. Subsequently, two authors independently reviewed the resulting database records, retrieved full texts for eligibility assessment, and extracted data from these cases.
RESULTS: We identified 18 papers describing thirty-five cases of penicillin- and cephalosporin-resistant S. pneumoniae meningitis including our
case. The patient\'s characteristics were; median age: 50 years, men:50%, 85% of cases received combination regimens of antibiotics: Ceftroriaxone (CTRX) plus VCM (20 cases), CTRX plus VCM plus rifampicin (RFP) (two cases), CTRX plus linezolid (one
case), fluoroquinolones (two cases), carbapenems (six cases), Thirty-five percent received steroids. Twenty-four percent of patients died. Twenty-six percent of patients complicated neurological sequalae.
CONCLUSIONS: Combination therapy including VCM plus LVFX could be a treatment option.