Broom Matthew, Best Emma, Heffernan Helen, Svensson Sara, Hansen Hygstedt Maria, Webb Rachel, Gow Nick, Holland David, Thomas Mark, Briggs Simon
Auckland City Hospital Infectious Diseases Department, Auckland District Health Board, 2 Park Road, Grafton, Auckland, 1023, New Zealand.
North Shore Hospital Infectious Diseases Department, Waitemata District Health Board, 124 Shakespeare Road, Takapuna, Auckland, 0620, New Zealand.
Infection. 2023 Apr;51(2):425-432. doi: 10.1007/s15010-022-01897-6. Epub 2022 Aug 18.
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.
Retrospective study of all culture positive IMD in adult patients (age ≥ 15 years) in the Auckland region from 2004 to 2017.
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.
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.
本研究旨在评估成人侵袭性脑膜炎球菌病（IMD）的临床结局，并比较由青霉素敏感菌株（最低抑菌浓度（MIC）≤0.06mg/L）引起的IMD患者与由青霉素敏感性降低菌株（MIC＞0.06mg/L）引起的IMD患者的结局。我们还评估了仅接受静脉注射苄星青霉素治疗的青霉素敏感性降低菌株引起的IMD患者的结局。
对2004年至2017年奥克兰地区成年患者（年龄≥15岁）中所有培养阳性的IMD进行回顾性研究。
共纳入139例患者；94例为青霉素敏感菌株（88例治愈，6例死亡），45例为青霉素敏感性降低菌株（41例治愈，1例可能复发，3例死亡）。两组苄星青霉素/头孢曲松的中位治疗时间均为3天。两组患者的结局无差异。18例由青霉素敏感性降低菌株引起的IMD患者仅接受苄星青霉素治疗并治愈。
本研究为现有数据提供了进一步支持，这些数据表明短疗程静脉注射β-内酰胺治疗对成人IMD有效。仅少数由青霉素敏感性降低菌株引起的脑膜炎患者仅接受苄星青霉素治疗，限制了对其的评估。对于脑膜炎奈瑟菌脑膜炎，我们建议将头孢曲松作为经验性治疗药物，以及在由青霉素敏感性降低菌株引起时作为确定性治疗药物。
