Mediterranean Journal of Infection, Microbes and Antimicrobials (Dec 2013)
A Case of Streptococcus pneumoniae Meningitis with Decreased Susceptibility to Third-Generation Cephalosporins
Abstract
Streptococcus pneumoniae is the most frequently encountered microorganism in the etiology of community-acquired acute bacterial meningitis. In Turkey, third-generation cephalosporin resistance is extremely rare in S. pneumoniae. Third-generation cephalosporins are the most commonly used antimicrobial agents in the treatment of pneumococcal meningitis. In this paper, we report a meningitis case of S. pneumoniae with decreased susceptibility to third-generation cephalosporins. A 56-year-old man admitted to our clinic with headache, nausea-vomiting and fever in March 2012. In the physical examination, his Glasgow coma scale was 15 and his cooperation and orientation were normal. He did not have any meningeal irritation finding. His physical examination did not reveal any other pathology. Lumbar puncture revealed turbid cerebrospinal fluid (CSF) with a white cell count of > 1000 cells/mm3 with 80% polymorphonuclear leukocytes. CSF laboratory findings were as follows: glucose level < 2 g/dL and protein level 255 mg/dL. Gram staining of CSF revealed gram-positive diplococci. Ceftriaxone was started. Vancomycin was added after blood and CSF cultures yielded S. pneumoniae with intermediate susceptibility to cefotaxime. On the seventh day, rifampicin was added due to the persistence of fever. CSF findings were normal at the end of the treatment. The patient was discharged after 28 days of antibiotherapy. The patient did not develop any relapse after eight months of follow-up. To our knowledge, this is the first S. pneumoniae meningitis case from Turkey with intermediate susceptibility to cefotaxime who was treated successfully. The presented case emphasizes the importance of CSF sampling and penicillin and ceftriaxone minimum inhibitory concentration (MIC) evaluation in the management of meningitis.
