Ishikawa Kazuhiro, Matsuo Takahiro, Suzuki Takahiro, Kawai Fujimi, Uehara Yuki, Mori Nobuyoshi
Department of Infectious Diseases, St. Luke's International Hospital, Tokyo, Japan.
Department of Infectious Diseases, St. Luke's International Hospital, Tokyo, Japan.
J Infect Chemother. 2022 May;28(5):663-668. doi: 10.1016/j.jiac.2022.01.021. Epub 2022 Feb 8.
Treatment of patients with penicillin-resistant S. pneumoniae (PRSP) is complicated because of the relatively poor blood-brain barrier penetration of effective antimicrobials. Our case: A previously healthy 70-year-old woman, a traveler from China to Japan, was admitted to our hospital with fever and loss of consciousness. She has no history of pneumococcal vaccination. She was diagnosed with bacterial meningitis due to penicillin-and third-generation cephalosporin-resistant strains of S. pneumoniae. The patient was successfully treated with a combination therapy of vancomycin (VCM) and levofloxacin (LVFX) and recovered without any neurological sequelae. As the treatment of penicillin-and third-generation cephalosporin-resistant strains of S. pneumoniae meningitis remains unclear, we conducted a review of the reported cases of meningitis caused by penicillin- and cephalosporin-resistant S. pneumoniae.
We performed a search using the keywords "penicillin-resistant Streptococcus pneumoniae," "meningitis," and "pneumococcal meningitis". We searched the electronic databases PubMed, Embase, and Ichushi from their inception to March 2020. Subsequently, two authors independently reviewed the resulting database records, retrieved full texts for eligibility assessment, and extracted data from these cases.
We identified 18 papers describing thirty-five cases of penicillin- and cephalosporin-resistant S. pneumoniae meningitis including our case. The patient's characteristics were; median age: 50 years, men:50%, 85% of cases received combination regimens of antibiotics: Ceftroriaxone (CTRX) plus VCM (20 cases), CTRX plus VCM plus rifampicin (RFP) (two cases), CTRX plus linezolid (one case), fluoroquinolones (two cases), carbapenems (six cases), Thirty-five percent received steroids. Twenty-four percent of patients died. Twenty-six percent of patients complicated neurological sequalae.
Combination therapy including VCM plus LVFX could be a treatment option.
由于有效的抗菌药物对血脑屏障的穿透性相对较差，耐青霉素肺炎链球菌（PRSP）患者的治疗较为复杂。我们的病例：一名既往健康的70岁女性，从中国前往日本的旅行者，因发热和意识丧失入住我院。她没有肺炎球菌疫苗接种史。她被诊断为细菌性脑膜炎，由耐青霉素和第三代头孢菌素的肺炎链球菌菌株引起。该患者接受万古霉素（VCM）和左氧氟沙星（LVFX）联合治疗成功治愈，且未遗留任何神经后遗症。由于耐青霉素和第三代头孢菌素的肺炎链球菌脑膜炎的治疗方法仍不明确，我们对已报道的耐青霉素和头孢菌素的肺炎链球菌引起的脑膜炎病例进行了综述。
我们使用关键词“耐青霉素肺炎链球菌”“脑膜炎”和“肺炎球菌性脑膜炎”进行检索。我们检索了电子数据库PubMed、Embase和Ichushi，检索时间从其创建至2020年3月。随后，两位作者独立审查所得的数据库记录，检索全文进行资格评估，并从这些病例中提取数据。
我们确定了18篇描述35例耐青霉素和头孢菌素的肺炎链球菌脑膜炎病例的论文，包括我们的病例。患者特征为：年龄中位数：50岁，男性占50%，85%的病例接受抗生素联合治疗方案：头孢曲松（CTRX）加VCM（20例），CTRX加VCM加利福平（RFP）（2例），CTRX加利奈唑胺（1例），氟喹诺酮类（2例），碳青霉烯类（6例），35%的患者接受了类固醇治疗。24%的患者死亡。26%的患者出现神经后遗症。
包括VCM加LVFX的联合治疗可能是一种治疗选择。
