M W Ryan1, P J Antonelli. 1. Department of Otolaryngology, University of Florida, Gainesville, USA.
Abstract
OBJECTIVES/HYPOTHESIS: Recent studies have shown alarmingly high rates of antibiotic resistance in Streptococcus pneumoniae isolates from patients with otitis media. A recent study has implicated resistant S pneumoniae for rising rates of acute mastoiditis. The purpose of this study was to determine whether S pneumoniae antibiotic resistance has similarly affected the rate of pediatric community-acquired meningitis, the most common intracranial complication of otitis media. STUDY DESIGN: Retrospective chart review. METHODS: All cases of pediatric community-acquired meningitis treated at an academic tertiary care hospital during a 10-year period were reviewed, and meningitis rates were calculated as a proportion of yearly admissions. RESULTS: The overall rate of meningitis decreased linearly during the study period (P = .001). This was largely because of a drop in the rate of Haemophilus influenzae meningitis (P = .001), corresponding with the introduction of H influenzae type B vaccine. Annual rates of S pneumoniae meningitis did not change. Only one case of S pneumoniae meningitis was due to a highly penicillin-resistant strain and isolates from four cases had intermediate sensitivity. Twenty-four of 83 cases were associated with antecedent acute otitis media and 63% of these had been treated with antibiotics before admission. Otitis media, as a cause of meningitis, did not increase during the study period. CONCLUSION: S pneumoniae is responsible for a greater proportion of cases of pediatric community-acquired meningitis. However, this is because of a decline in the rate of H influenzae cases, not the rise in S pneumoniae antibiotic resistance.
OBJECTIVES/HYPOTHESIS: Recent studies have shown alarmingly high rates of antibiotic resistance in Streptococcus pneumoniae isolates from patients with otitis media. A recent study has implicated resistant S pneumoniae for rising rates of acute mastoiditis. The purpose of this study was to determine whether S pneumoniae antibiotic resistance has similarly affected the rate of pediatric community-acquired meningitis, the most common intracranial complication of otitis media. STUDY DESIGN: Retrospective chart review. METHODS: All cases of pediatric community-acquired meningitis treated at an academic tertiary care hospital during a 10-year period were reviewed, and meningitis rates were calculated as a proportion of yearly admissions. RESULTS: The overall rate of meningitis decreased linearly during the study period (P = .001). This was largely because of a drop in the rate of Haemophilus influenzae meningitis (P = .001), corresponding with the introduction of H influenzae type B vaccine. Annual rates of S pneumoniae meningitis did not change. Only one case of S pneumoniae meningitis was due to a highly penicillin-resistant strain and isolates from four cases had intermediate sensitivity. Twenty-four of 83 cases were associated with antecedent acute otitis media and 63% of these had been treated with antibiotics before admission. Otitis media, as a cause of meningitis, did not increase during the study period. CONCLUSION: S pneumoniae is responsible for a greater proportion of cases of pediatric community-acquired meningitis. However, this is because of a decline in the rate of H influenzae cases, not the rise in S pneumoniae antibiotic resistance.
Authors: M A Barocchi; J Ries; X Zogaj; C Hemsley; B Albiger; A Kanth; S Dahlberg; J Fernebro; M Moschioni; V Masignani; K Hultenby; A R Taddei; K Beiter; F Wartha; A von Euler; A Covacci; D W Holden; S Normark; R Rappuoli; B Henriques-Normark Journal: Proc Natl Acad Sci U S A Date: 2006-02-15 Impact factor: 11.205