Hakan Erdem1, Nazif Elaldi2, Nefise Öztoprak3, Gonul Sengoz4, Oznur Ak5, Selcuk Kaya6, Asuman Inan7, Saygın Nayman-Alpat8, Ayşegül Ulu-Kilic9, Abdullah Umut Pekok10, Alper Gunduz11, Mustafa G Gozel2, Filiz Pehlivanoglu4, Kadriye Yasar12, Hava Yılmaz13, Mustafa Hatipoglu14, Gonul Cicek-Senturk15, Fusun Z Akcam16, Ahmet C Inkaya17, Esra Kazak18, Ayşe Sagmak-Tartar19, Recep Tekin20, Derya Ozturk-Engin7, Yasemin Ersoy21, Oguz Resat Sipahi22, Tumer Guven23, Gunay Tuncer-Ertem24, Selma Alabay9, Ayhan Akbulut19, Ilker I Balkan25, Oral Oncul14, Birsen Cetin26, Saim Dayan20, Gulden Ersoz27, Ahmet Karakas28, Nail Ozgunes29, Alper Sener30, Aysegul Yesilkaya31, Ayse Erturk32, Sibel Gundes33, Oguz Karabay34, Fatma Sirmatel35, Selma Tosun36, Vedat Turhan14, Aysun Yalci37, Yasemin Akkoyunlu38, Emsal Aydın39, Husrev Diktas40, Sukran Kose41, Asim Ulcay14, Derya Seyman3, Umit Savasci42, Hakan Leblebicioglu13, Haluk Vahaboglu29. 1. GATA Haydarpasa Training Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey. Electronic address: hakanerdem1969@yahoo.com. 2. Cumhuriyet University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Sivas, Turkey. 3. Antalya Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Antalya, Turkey. 4. Haseki Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey. 5. Lutfi Kirdar Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey. 6. Karadeniz Technical University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Trabzon, Turkey. 7. Haydarpasa Numune Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey. 8. Osmangazi University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Eskisehir, Turkey. 9. Erciyes University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Kayseri, Turkey. 10. Private Erzurum Sifa Hospital, Department of Infectious Diseases and Clinical Microbiology, Erzurum, Turkey. 11. Sisli Etfal Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey. 12. Bakırkoy Dr. Sadi Konuk Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey. 13. Ondokuz Mayis University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Samsun, Turkey. 14. GATA Haydarpasa Training Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey. 15. Diskapi Yildirim Beyazit Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey. 16. Suleyman Demirel University, School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Isparta, Turkey. 17. Hacettepe University, School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey. 18. Uludag University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Bursa, Turkey. 19. Firat University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Elazig, Turkey. 20. Dicle University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Diyarbakir, Turkey. 21. Inonu University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Malatya, Turkey. 22. Ege University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Izmir, Turkey. 23. Ankara Atatürk Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey. 24. Ankara Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey. 25. Istanbul University Cerrahpasa School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey. 26. Koc University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey. 27. Mersin University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Mersin, Turkey. 28. Gulhane Medical Academy, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey. 29. Medeniyet University, Goztepe Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey. 30. Onsekiz Mart University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Canakkale, Turkey. 31. Baskent University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey. 32. Recep Tayyip Erdoğan University, School of Medicine, Department of Department of Infectious Diseases and Clinical Microbiology, Rize, Turkey. 33. Kocaeli University School of Medicine, Department of Department of Infectious Diseases and Clinical Microbiology, Izmit, Turkey. 34. Sakarya University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Sakarya, Turkey. 35. Izzet Baysal University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Bolu, Turkey. 36. Izmir Bozyaka Training and Research Hospital, Department of Infectious diseases and Clinical Microbiology, Izmir, Turkey. 37. Ankara University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey. 38. Bezmi Alem Vakif University, School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey. 39. Kafkas University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Kars, Turkey. 40. Military Hospital, Department of Infectious Diseases and Clinical Microbiology, Tatvan, Turkey. 41. Tepecik Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Izmir, Turkey. 42. Department of Infectious Diseases and Clinical Microbiology, Sarikamis Military Hospital, Kars, Turkey.
Abstract
BACKGROUND: The aim of this study was to delineate mortality indicators in pneumococcal meningitis with special emphasis on therapeutic implications. METHODS: This retrospective, multicenter cohort study involved a 15-year period (1998-2012). Culture-positive cases (n=306) were included solely from 38 centers. RESULTS: Fifty-eight patients received ceftriaxone plus vancomycin empirically. The rest were given a third-generation cephalosporin alone. Overall, 246 (79.1%) isolates were found to be penicillin-susceptible, 38 (12.2%) strains were penicillin-resistant, and 22 (7.1%) were oxacillin-resistant (without further minimum inhibitory concentration testing for penicillin). Being a critical case (odds ratio (OR) 7.089, 95% confidence interval (CI) 3.230-15.557) and age over 50 years (OR 3.908, 95% CI 1.820-8.390) were independent predictors of mortality, while infection with a penicillin-susceptible isolate (OR 0.441, 95% CI 0.195-0.996) was found to be protective. Empirical vancomycin use did not provide significant benefit (OR 2.159, 95% CI 0.949-4.912). CONCLUSIONS: Ceftriaxone alone is not adequate in the management of pneumococcal meningitis due to penicillin-resistant pneumococci, which is a major concern worldwide. Although vancomycin showed a trend towards improving the prognosis of pneumococcal meningitis, significant correlation in statistical terms could not be established in this study. Thus, further studies are needed for the optimization of pneumococcal meningitis treatment.
BACKGROUND: The aim of this study was to delineate mortality indicators in pneumococcal meningitis with special emphasis on therapeutic implications. METHODS: This retrospective, multicenter cohort study involved a 15-year period (1998-2012). Culture-positive cases (n=306) were included solely from 38 centers. RESULTS: Fifty-eight patients received ceftriaxone plus vancomycin empirically. The rest were given a third-generation cephalosporin alone. Overall, 246 (79.1%) isolates were found to be penicillin-susceptible, 38 (12.2%) strains were penicillin-resistant, and 22 (7.1%) were oxacillin-resistant (without further minimum inhibitory concentration testing for penicillin). Being a critical case (odds ratio (OR) 7.089, 95% confidence interval (CI) 3.230-15.557) and age over 50 years (OR 3.908, 95% CI 1.820-8.390) were independent predictors of mortality, while infection with a penicillin-susceptible isolate (OR 0.441, 95% CI 0.195-0.996) was found to be protective. Empirical vancomycin use did not provide significant benefit (OR 2.159, 95% CI 0.949-4.912). CONCLUSIONS:Ceftriaxone alone is not adequate in the management of pneumococcal meningitis due to penicillin-resistant pneumococci, which is a major concern worldwide. Although vancomycin showed a trend towards improving the prognosis of pneumococcal meningitis, significant correlation in statistical terms could not be established in this study. Thus, further studies are needed for the optimization of pneumococcal meningitis treatment.
Authors: H Erdem; A Inan; E Guven; S Hargreaves; L Larsen; G Shehata; E Pernicova; E Khan; L Bastakova; S Namani; A Harxhi; T Roganovic; B Lakatos; S Uysal; O R Sipahi; A Crisan; E Miftode; R Stebel; B Jegorovic; Z Fehér; C Jekkel; N Pandak; A Moravveji; H Yilmaz; A Khalifa; U Musabak; S Yilmaz; A Jouhar; N Oztoprak; X Argemi; M Baldeyrou; G Bellaud; R V Moroti; R Hasbun; L Salazar; R Tekin; A Canestri; L Čalkić; L Praticò; F Yilmaz-Karadag; L Santos; A Pinto; F Kaptan; P Bossi; J Aron; A Duissenova; G Shopayeva; B Utaganov; S Grgic; G Ersoz; A K L Wu; K C Lung; A Bruzsa; L B Radic; H Kahraman; M Momen-Heravi; S Kulzhanova; F Rigo; M Konkayeva; Z Smagulova; T Tang; P Chan; S Ahmetagic; H Porobic-Jahic; F Moradi; S Kaya; Y Cag; A Bohr; C Artuk; I Celik; M Amsilli; H C Gul; A Cascio; M Lanzafame; M Nassar Journal: Eur J Clin Microbiol Infect Dis Date: 2017-04-10 Impact factor: 3.267
Authors: I N Hakyemez; H Erdem; G Beraud; M Lurdes; A Silva-Pinto; C Alexandru; B Bishop; F Mangani; X Argemi; M Poinot; R Hasbun; M Sunbul; M Akcaer; S Alp; T Demirdal; K Angamuthu; F Amer; E Ragab; G A Shehata; D Ozturk-Engin; N Ozgunes; L Larsen; S Zimmerli; O R Sipahi; E Tukenmez Tigen; G Celebi; N Oztoprak; A C Yardimci; Y Cag Journal: Eur J Clin Microbiol Infect Dis Date: 2017-12-08 Impact factor: 3.267
Authors: Eoin Clancy; Owen Higgins; Matthew S Forrest; Teck Wee Boo; Martin Cormican; Thomas Barry; Olaf Piepenburg; Terry J Smith Journal: BMC Infect Dis Date: 2015-10-29 Impact factor: 3.090
Authors: Timothy Letsa; Charles Lwanga Noora; George Khumalo Kuma; Ernest Asiedu; Gideon Kye-Duodu; Edwin Afari; Osei Afreh Kuffour; Joseph Opare; Kofi Mensah Nyarko; Donne Kofi Ameme; Emmanuel G Bachan; Kofi Issah; Franklin Aseidu-Bekoe; Moses Aikins; Ernest Kenu Journal: BMC Public Health Date: 2018-06-22 Impact factor: 3.295