327. Comparison of clinical outcome, causative serotypes, and antimicrobial susceptibilities between pneumococcal meningitis and pneumococcal bacteremic pneumonia in adult patients in the Republic of Korea
Session: Poster Abstract Session: CNS Infections
Thursday, October 4, 2018
Room: S Poster Hall
Background: Pneumococcal meningitis (PM) is one of invasive pneumococcal disease (IPD) and is considered as a medical emergency with notable morbidity and mortality. This study was designed to characterize differences in clinical characteristics and outcomes , pneumococcal serotypes, and antimicrobial susceptibilities between PM and pneumococcal bacteremic pneumonia (PBP) in adult patients in the Republic of Korea (ROK) from a prospective observational cohort.

Methods: Adult IPD cases (≥ 18 years) were prospectively collected from 20 hospitals participated in the pneumococcal surveillance program in the ROK from 2013 through 2015. Serotyping and antimicrobial susceptibility testing were performed by a multiplexed serotyping assay and Microscan system, respectively.

Results: During the study period, 30 cases of PM and 205 cases of PBP were compared. Serotypes 19A, 15B/15C, and 35B were the most prevalent among PM cases, whereas serotypes 3, 11A/D/F, and 19A were the most common serotypes in PBP. There were significant female predominance (46.7% vs 2.3%, p=0.022), younger age (56.7% vs 36.1%, p=0.031), less immunocompromised states (3.3% vs 28.8%, p=0.005), less underlying chronic lung diseases (3.3% vs 16.6%, p=0.04), and lower mortality rate (16.7% vs 44.4%, p=0.004) in PM, compared to PBP. However, PM cases showed higher penicillin resistance (76.7% vs 19.2%, p <0.001), and ceftriaxone resistance (53.3% vs 13.4%, p <0.001), consistent with higher MDR prevalence in PM cases (76.7% vs 53.2 P=0.016). All PM cases except for 3 cases received empiric or definite vancomycin treatment. Multiple logistic regression analysis showed that penicillin resistance (odds ratio [OR] 15.75, 95% confidence interval (CI) 3.82-64.72, p<0.001) and survival (OR 20.73, 95% CI 3.1-136.74, p = 0.002) were significantly associated with PM.

Conclusion: This study indicates that adult PM showed favorable clinical outcomes, compared to PBP, despite of differences in clinical characteristics.

Jeong Yeon Kim, MD1, Jong Hun Kim, MD2, Dong-Min Kim, MD3, In-Gyu Bae, MD4, Yeon-Sook Kim, MD5, Hyo Youl Kim, MD, PhD6, Seung Hee Baik, MD7, Young Hwa Choi, MD, PhD8, Yu Mi Jo, MD9, Joon Young Song, MD10, Hyun Hee Kwon, M.D11, Hye Won Jeong, M.D. Ph.D.12, Jeong Yeon Kim, M.D., Ph.D.13, Ji an Hur, MD14, Sun Bean Kim, MD15, Young Kyung Yoon, MD., Ph.D16, Jang-Wook Sohn, MD., Ph.D.16 and Min-Ja Kim, MD., Ph.D16, (1)Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea, Republic of (South), (2)Division of Infectious Diseases, Korea University College of Medicine, Seoul, Korea, Republic of (South), (3)School of Medicine, Chosun University, gwang ju, Korea, Republic of (South), (4)Gyeongsang National University Hospital, Jinju, Korea, Republic of (South), (5)Chungnam National University School Of Medicine, Daejon, Korea, Republic of (South), (6)Division of Infectious Diseases, Yonsei University Wonju College of Medicine, Wonju, Korea, Republic of (South), (7)Cheju Halla General Hospital, Jeju-si, Korea, Republic of (South), (8)Department of Infectious Diseases, Ajou University School of Medicine, Suwon, Korea, Republic of (South), (9)Division of Infectious Diseases, Gachon University Gil Medical Center, Incheon, Korea, Republic of (South), (10)Korea University College of Medicine, Seoul, Korea, Republic of (South), (11)Infectious Disease, Catholic University of Daegu School of Medicine, Daegu, Korea, Republic of (South), (12)Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea, Republic of (South), (13)Sahmyook Medical Center, Seoul, Korea, Republic of (South), (14)Youngnam University Hospital, Daegu, Korea, Republic of (South), (15)Internal Medicine, Korea University College of Medicine, Seoul, Korea, Republic of (South), (16)Division of Infectious Disease, Depart of Internal Medicine, Korea University Medical Center, Seoul, Korea, Republic of (South)

Disclosures:

J. Y. Kim, None

J. H. Kim, None

D. M. Kim, None

I. G. Bae, None

Y. S. Kim, None

H. Y. Kim, None

S. H. Baik, None

Y. H. Choi, None

Y. M. Jo, None

J. Y. Song, None

H. H. Kwon, None

H. W. Jeong, None

J. Y. Kim, None

J. A. Hur, None

S. B. Kim, None

Y. K. Yoon, None

J. W. Sohn, None

M. J. Kim, None

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