214. Clinical implication of extended-spectrum cephalosporin resistance in Streptococcus pneumoniae meningitis
Session: Poster Abstract Session: Antimicrobial Resistance: Clinical Studies
Friday, October 21, 2011
Room: Poster Hall B1
Background: The clinical implications of extended-spectrum cephalosporin (ESC) resistance remain unclear in patients with Streptococcus pneumoniae meningitis (SPM).

Methods: We performed a retrospective multi-center study of patients with SPM from 12 tertiary-care centers in the Republic of Korea. Of the patients with SPM, we included only those who underwent ESC E-testing, as well as those with penicillin-susceptible strains without ESC E-testing who were considered ESC-susceptible. Antimicrobial susceptibilities were determined according to the CLSI guidelines. Unfavorable outcomes were defined as any in-hospital death or a Glasgow Outcome Scale (GOS) score of 1−4 at discharge.

Results: Between 1991 and 2010, a total of 148 episodes of SPM were identified in 142 patients. Of these 148 episodes, 90 of SPM were included in the analysis. Fifteen of these 90 strains (16.7%) were ESC resistant. ESC-nonsusceptible SPM was more commonly associated with a history of head/ear/sinus surgery or head trauma (60.0% vs. 25.3%, p = 0.01), and with hospital acquisition (20.0% vs. 1.3%, p = 0.01). Although the initial level of consciousness and Glasgow Coma Scale scores did not differ in patients with ESC-nonsusceptible and ESC-susceptible SPM, bacteremia (93.3% vs. 56.9%, p = 0.01) and septic shock (38.5% vs. 6.8%, p = 0.01) were more common in patients with ESC-nonsusceptible SPM. In-hospital mortality occurred in 18 of 85 patients (21.2%) and unfavorable outcomes in 34 of 85 (40.0%). Although not statistically significant (p = 0.29), the in-hospital mortality rate was higher in patients with ESC-nonsusceptible SPM (33.3% vs. 18.6%). Unfavorable outcomes occurred more commonly in patients with ESC-nonsusceptible SPM (66.7% vs. 34.3%, p = 0.02), mainly due to differences in 3-day mortality (26.7% vs. 4.3%, p = 0.02) and Glasgow Outcome Scale scores of 2−4 (50.0% vs. 19.3%, p = 0.05), without any differences in antimicrobial therapy and early glucocorticoid use between patients with ESC-nonsusceptible SPM and those without.

Conclusion: SPM caused by ESC-nonsusceptible strains was more commonly associated with serious initial presentation, early mortality and late complications than ESC-susceptible SPM.


Subject Category: A. Antimicrobial agents and Resistance

Seong-Ho Choi, M. D. 1, Jin-Won Chung1, Baek-Nam Kim2, Yee Gyung Kwak, MD2, Tae Hyong Kim, MD3, Eun Jung Lee, MD3, Eun Ju Choo, MD4, Min Hyok Jeon, MD5, Mi Suk Lee, MD6, In-Gyu Bae, MD7, Sang-Rok Lee8, Eun Hee Song9, Jae-Bum Jun10, Mi-Na Kim, MD, PhD11, Sung-Han Kim, MD, PhD12, Sang-Oh Lee, MD12, Yang Soo Kim, MD, PhD12, Jun Hee Woo, MD, PhD13 and Sang-Ho Choi, MD, PhD13, (1)Division of Infectious Diseases, Department of Internal Medicine, Chung-Ang University Hospital, Seoul, South Korea, (2)Department of Internal Medicine, Inje University College of Medicine, Busan, South Korea, (3)Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, South Korea, (4)Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, South Korea, (5)Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, South Korea, (6)Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, South Korea, (7)Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, South Korea, (8)Department of Internal Medicine, Cheongju St. Mary’s Hospital, Cheongju, South Korea, (9)Department of Infectious Diseases, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, South Korea, (10)Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea, (11)Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea, (12)Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea, (13)Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea, Republic of

Disclosures:

S. H. Choi, None

J. W. Chung, None

B. N. Kim, None

Y. G. Kwak, None

T. H. Kim, None

E. J. Lee, None

E. J. Choo, None

M. H. Jeon, None

M. S. Lee, None

I. G. Bae, None

S. R. Lee, None

E. H. Song, None

J. B. Jun, None

M. N. Kim, None

S. H. Kim, None

S. O. Lee, None

Y. S. Kim, None

J. H. Woo, None

S. H. Choi, None

Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.