Matthew Broom1,2, Emma Best3,4, Helen Heffernan5, Sara Svensson6,7,8, Maria Hansen Hygstedt6,7,9, Rachel Webb10, Nick Gow11, David Holland12, Mark Thomas6,13, Simon Briggs6. 1. Auckland City Hospital Infectious Diseases Department, Auckland District Health Board, 2 Park Road, Grafton, Auckland, 1023, New Zealand. Matthew.Broom@waitematadhb.govt.nz. 2. North Shore Hospital Infectious Diseases Department, Waitemata District Health Board, 124 Shakespeare Road, Takapuna, Auckland, 0620, New Zealand. Matthew.Broom@waitematadhb.govt.nz. 3. Starship Hospital Infectious Diseases Department, Auckland District Health Board, 2 Park Road, Grafton, Auckland, 1023, New Zealand. 4. Department of Paediatrics, University of Auckland, Level 12, Support Building Auckland City Hospital, 2 Park Road, Grafton, Auckland, 1023, New Zealand. 5. The Institute of Environmental Science and Research, 34 Kenepuru Drive, Kenepuru, Porirua, New Zealand. 6. Auckland City Hospital Infectious Diseases Department, Auckland District Health Board, 2 Park Road, Grafton, Auckland, 1023, New Zealand. 7. University of Gothenburg, 405 30, Gothenburg, Sweden. 8. Norra Ӓlvsborgs Lӓnssjukhus, Lӓrketorpsvӓgen, 461 73, Trollhӓttan, Sweden. 9. , Ӧgonkliniken, Lansmansgatan 20, 431 30, Molndal, Sweden. 10. Middlemore Hospital Kidz First Infectious Diseases Department, Counties Manukau District Health Board, 100 Hospital Road, Middlemore, Auckland, 2025, New Zealand. 11. North Shore Hospital Infectious Diseases Department, Waitemata District Health Board, 124 Shakespeare Road, Takapuna, Auckland, 0620, New Zealand. 12. Middlemore Hospital Infectious Diseases Department, Counties Manukau District Health Board, 100 Hospital Road, Middlemore, Auckland, 2025, New Zealand. 13. Department of Molecular Medicine, University of Auckland, Grafton Campus, Grafton, Auckland, 1023, New Zealand.
Abstract
PURPOSE: The purpose of this study was to assess the clinical outcomes of adults with invasive meningococcal disease (IMD) and to compare the outcomes of patients with IMD caused by a penicillin susceptible isolate (minimum inhibitory concentration (MIC) ≤ 0.06 mg/L) with patients with IMD caused by an isolate with reduced penicillin susceptibility (MIC > 0.06 mg/L). We also assessed the outcomes of patients with IMD caused by an isolate with reduced penicillin susceptibility who were treated exclusively with intravenous (IV) benzylpenicillin. METHODS: Retrospective study of all culture positive IMD in adult patients (age ≥ 15 years) in the Auckland region from 2004 to 2017. RESULTS: One hundred and thirty-nine patients were included; 94 had penicillin susceptible isolates (88 cured, 6 died), and 45 had an isolate with reduced penicillin susceptibility (41 cured, 1 possible relapse, 3 died). The median benzylpenicillin/ceftriaxone treatment duration was 3 days for both groups. There was no difference in the patient outcomes of both groups. Eighteen patients with IMD caused by an isolate with reduced penicillin susceptibility received benzylpenicillin alone and were cured. CONCLUSIONS: This study provides further support to existing data that has shown that short duration IV beta-lactam treatment is effective for IMD in adults. Only a small number of patients with meningitis caused by an isolate with reduced penicillin susceptibility received benzylpenicillin alone, limiting its evaluation. For Neisseria meningitidis meningitis, we recommend ceftriaxone as empiric treatment and as definitive treatment when this is caused by an isolate with reduced penicillin susceptibility.
PURPOSE: The purpose of this study was to assess the clinical outcomes of adults with invasive meningococcal disease (IMD) and to compare the outcomes of patients with IMD caused by a penicillin susceptible isolate (minimum inhibitory concentration (MIC) ≤ 0.06 mg/L) with patients with IMD caused by an isolate with reduced penicillin susceptibility (MIC > 0.06 mg/L). We also assessed the outcomes of patients with IMD caused by an isolate with reduced penicillin susceptibility who were treated exclusively with intravenous (IV) benzylpenicillin. METHODS: Retrospective study of all culture positive IMD in adult patients (age ≥ 15 years) in the Auckland region from 2004 to 2017. RESULTS: One hundred and thirty-nine patients were included; 94 had penicillin susceptible isolates (88 cured, 6 died), and 45 had an isolate with reduced penicillin susceptibility (41 cured, 1 possible relapse, 3 died). The median benzylpenicillin/ceftriaxone treatment duration was 3 days for both groups. There was no difference in the patient outcomes of both groups. Eighteen patients with IMD caused by an isolate with reduced penicillin susceptibility received benzylpenicillin alone and were cured. CONCLUSIONS: This study provides further support to existing data that has shown that short duration IV beta-lactam treatment is effective for IMD in adults. Only a small number of patients with meningitis caused by an isolate with reduced penicillin susceptibility received benzylpenicillin alone, limiting its evaluation. For Neisseria meningitidis meningitis, we recommend ceftriaxone as empiric treatment and as definitive treatment when this is caused by an isolate with reduced penicillin susceptibility.
Authors: Carmen Cabellos; Ivan Pelegrín; Eva Benavent; Francesc Gudiol; Fe Tubau; Dolores Garcia-Somoza; Ricard Verdaguer; Javier Ariza; Pedro Fernandez-Viladrich Journal: J Infect Date: 2017-08-25 Impact factor: 6.072