Mortality indicators in pneumococcal meningitis: therapeutic implications

• DOI: 10.1016/j.ijid.2013.09.012
• Publication Date: 2013-10-30T03:30:55Z
• Authors: Hakan Erdem; Nazif Elaldi; Nefise Öztoprak; Gonul Sengoz; Oznur Ak; Selcuk Kaya; Asuman Inan; Saygın Nayman-Alpat; Ayşegül Ulu-Kilic; Abdullah Umut Pekok; Alper Gunduz; Mustafa G. Gozel; Filiz Pehlivanoglu; Kadriye Yasar; Hava Yılmaz; Mustafa Hatipoglu; Gonul Cicek-Senturk; Fusun Z. Akcam; Ahmet C. Inkaya; Esra Kazak; Ayşe Sagmak-Tartar; Recep Tekin; Derya Ozturk-Engin; Yasemin Ersoy; Oguz Resat Sipahi; Tumer Guven; Gunay Tuncer-Ertem; Selma Alabay; Ayhan Akbulut; Ilker I. Balkan; Oral Oncul; Birsen Cetin; Saim Dayan; Gulden Ersoz; Ahmet Karakas; Nail Ozgunes; Alper Sener; Aysegul Yesilkaya; Ayse Erturk; Sibel Gundes; Oguz Karabay; Fatma Sirmatel; Selma Tosun; Vedat Turhan; Aysun Yalci; Yasemin Akkoyunlu; Emsal Aydın; Husrev Diktas; Sukran Kose; Asim Ulcay; Derya Seyman; Umit Savasci; Hakan Leblebicioglu; Haluk Vahaboglu
• Keywords: Pneumococcal infections

BackgroundThe aim of this study was to delineate mortality indicators in pneumococcal meningitis with special emphasis on therapeutic implications.MethodsThis retrospective, multicenter cohort involved a 15-year period (1998–2012). Culture-positive cases (n = 306) were included solely from 38 centers.ResultsFifty-eight patients received ceftriaxone plus vancomycin empirically. The rest given third-generation cephalosporin alone. Overall, 246 (79.1%) isolates found be penicillin-susceptible, (12.2%) strains penicillin-resistant, and 22 (7.1%) oxacillin-resistant (without further minimum inhibitory concentration testing for penicillin). Being critical case (odds ratio (OR) 7.089, 95% confidence interval (CI) 3.230–15.557) age over 50 years (OR 3.908, CI 1.820–8.390) independent predictors mortality, while infection penicillin-susceptible isolate 0.441, 0.195–0.996) protective. Empirical use did not provide significant benefit 2.159, 0.949–4.912).ConclusionsCeftriaxone alone is adequate the management due penicillin-resistant pneumococci, which major concern worldwide. Although showed trend towards improving prognosis meningitis, correlation statistical terms could established study. Thus, studies are needed optimization treatment.