ABSTRACT
BACKGROUND: Prior to the availability of generic third-generation cephalosporins, penicillins were widely used for treatment of pneumococcal meningitis in developing countries despite concerns about rising levels of penicillin resistance among pneumococcal isolates. We examined the impact of penicillin resistance on outcomes of pneumococcal meningitis over a ten year period in an infectious diseases hospital in Brazil. METHODS: Clinical presentation, antimicrobial therapy and outcomes were reviewed for 548 patients with culture-confirmed pneumococcal meningitis from December, 1995, to November, 2005. Pneumococcal isolates from meningitis patients were defined as penicillin-resistant if Minimum Inhibitory Concentrations for penicillin were greater than 0.06 µg/ml. Proportional hazards regression was used to identify risk factors for fatal outcomes. RESULTS: During the ten-year period, ceftriaxone replaced ampicillin as first-line therapy for suspected bacterial meningitis. In hospital case-fatality for pneumococcal meningitis was 37%. Of 548 pneumococcal isolates from meningitis cases, 92 (17%) were resistant to penicillin. After controlling for age and severity of disease at admission, penicillin resistance was associated with higher case-fatality (Hazard Ratio [HR], 1.62; 95% Confidence Interval [CI], 1.08-2.43). Penicillin-resistance remained associated with higher case-fatality when initial therapy included ceftriaxone (HR, 1.68; 95% CI 1.02-2.76). CONCLUSIONS: Findings support the use of third generation cephalosporin antibiotics for treatment of suspected pneumococcal meningitis even at low prevalence of pneumococcal resistance to penicillins.
Subject(s)
Anti-Bacterial Agents/administration & dosage , Meningitis, Pneumococcal/drug therapy , Meningitis, Pneumococcal/microbiology , Penicillin Resistance , Streptococcus pneumoniae/drug effects , beta-Lactams/administration & dosage , Adolescent , Adult , Aged , Aged, 80 and over , Brazil , Child , Child, Preschool , Female , Hospitals , Humans , Infant , Infant, Newborn , Male , Meningitis, Pneumococcal/mortality , Microbial Sensitivity Tests , Middle Aged , Treatment Outcome , Young AdultABSTRACT
Seven individuals living in a town in the Southwest of Bahia developed sudden signs of cardiac and systemic impairment, with lethality of 28.6%. Serological tests were positive at least in one test in the five patients examined. Forty percent of the Triatoma sordida mynphs found inside or around Trypanosoma cruzi were found by blood culturig in there out five cases the homes of these cases were positive for Trypanosoma cruzi. Transmission probably occurred through consumption of water contaminated with triatomine feces. These findings emphasize the necessity to evaluation the importance of vectors like Triatoma sordida in maintaining the endemicity of this disease.
Subject(s)
Chagas Disease/epidemiology , Chagas Disease/transmission , Disease Outbreaks , Triatoma/parasitology , Water/parasitology , Acute Disease , Adolescent , Adult , Animals , Antibodies, Protozoan/blood , Brazil/epidemiology , Chagas Disease/diagnosis , Child , Disease Vectors , Female , Humans , Male , Trypanosoma cruzi/immunology , Trypanosoma cruzi/isolation & purificationABSTRACT
Seven individuals living in a town in the Southwest of Bahia developed sudden signs of cardiac and systemic impairment, with lethality of 28.6 percent. Serological tests were positive at least in one test in the five patients examined. Forty percent of the Triatoma sordida mynphs found inside or around Trypanosoma cruzi were found by blood culturig in there out five cases the homes of these cases were positive for Trypanosoma cruzi. Transmission probably occurred through consumption of water contaminated with triatomine feces. These findings emphasize the necessity to evaluation the importance of vectors like Triatoma sordida in maintaining the endemicity of this disease.
Sete indivíduos que viviam em uma cidade do sudoeste da Bahia desenvolveram sinais súbitos de envolvimento cardíaco e sistêmico com letalidade de 28,6 por cento Trypanosoma cruzi foi isolado por hemocultura em três de cinco casos examinados. Testes sorológicos foram positivos em mais de um teste nos cinco pacientes, que os realizaram. Qinquenta por cento dos Triatoma sordida encontrados na residência ou no peridomicilio dos casos estavam positivos para Trypanosoma cruzi. A transmissão provavelmente foi devido à ingestão de água contaminada por fezes de triatomíneos. Estes achados enfatizam a necessidade de se avaliar a importância de vetores como Triatoma sordida na manutenção da endemicidade da doença.
