Managing penicillin resistant pneumococcal meningitis: an international id-iri study

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dc.authorid0000-0002-0939-8049
dc.authorid0000-0002-6265-5227
dc.authorid0000-0002-6630-5742
dc.authorid0000-0001-9230-8616
dc.authorid0000-0002-6525-1818
dc.authorid0000-0002-3613-0523
dc.contributor.authorErdem, Hakan
dc.contributor.authorDogan, Elif
dc.contributor.authorAnkarali, Handan
dc.contributor.authorDragovac, Gorana
dc.contributor.authorSeyman, Derya
dc.contributor.authorTarakci, Arzu
dc.contributor.authorDalmanoglu, Enes
dc.date.accessioned2026-02-03T12:03:03Z
dc.date.available2026-02-03T12:03:03Z
dc.date.issued2025
dc.departmentÇanakkale Onsekiz Mart Üniversitesi
dc.description.abstractPenicillin-resistant pneumococcal meningitis (PRPM) is a challenging and fatal infection. We conducted a multicentre international retrospective study to evaluate the clinical features, outcomes, predictors of outcomes antimicrobial efficacy and drug susceptibility in patients with PRPM. The study, conducted through the Infectious Diseases-International Research Initiative across 33 centers in 11 countries, analyzed PRPM patients treated between 2019 and 2024 using univariate and multivariate analyses. A total of 138 patients were included. Of these, 83 (60.1%) were fully cured, 27 (19.6%) died, and 28 (20.3%) survived with sequelae. Mortality was associated with ICU admission (OR 14.886; p = 0.021), mechanical ventilation (OR 7.205; p = 0.049), and vasopressor use (OR 8.983; p = 0.025). Higher CSF leukocyte count (OR 0.854; p = 0.060) and blood leukocyte count (OR 0.283; p = 0.021) were linked to lower mortality risk. Patients who developed sequelae were more likely to require mechanical ventilation (OR 9.354; p = 0.001), experience recurrent meningitis (OR 5.562; p = 0.081), and have lower platelet counts (OR 0.001; p = 0.050), compared to those who fully recovered. Sequelae patients had higher GCS scores (OR 1.365; p = 0.014), more corticosteroid use (OR 5.301; p = 0.061), and less vasopressor use (OR 0.205; p = 0.019) compared to those who died. The antibiotic susceptibility profiles of the isolates in our PRSP cohort were: Ceftriaxone (75/134, 55.9%), meropenem (26/44, 59%), moxifloxacin (47/48, 97.9%). PRPM is a fatal disease in which mortality and sequelae occurring in two-fifths of cases. Severe illness markers such as ICU admission, mechanical ventilation, and vasopressor use, along with recurrent meningitis are linked to worse outcomes. Thrombocytopenia, low leukocyte counts, and lower GCS scores are indicators of poor prognosis, while corticosteroid therapy appears protective in PRPM. Therapeutic optimization is challenged by rising resistance and pharmacokinetic limitations, though moxifloxacin shows the highest susceptibility; further research is warranted.
dc.identifier.doi10.1007/s10096-025-05240-3
dc.identifier.endpage2866
dc.identifier.issn0934-9723
dc.identifier.issn1435-4373
dc.identifier.issue11
dc.identifier.pmid40892322
dc.identifier.scopus2-s2.0-105015102069
dc.identifier.scopusqualityQ1
dc.identifier.startpage2855
dc.identifier.urihttps://doi.org/10.1007/s10096-025-05240-3
dc.identifier.urihttps://hdl.handle.net/20.500.12428/34958
dc.identifier.volume44
dc.identifier.wosWOS:001561952600001
dc.identifier.wosqualityQ2
dc.indekslendigikaynakWeb of Science
dc.indekslendigikaynakScopus
dc.indekslendigikaynakPubMed
dc.language.isoen
dc.publisherSpringer
dc.relation.ispartofEuropean Journal of Clinical Microbiology & Infectious Diseases
dc.relation.publicationcategoryMakale - Uluslararası Hakemli Dergi - Kurum Öğretim Elemanı
dc.rightsinfo:eu-repo/semantics/closedAccess
dc.snmzKA_WOS_20260130
dc.subjectStreptococcus pneumoniae
dc.subjectPneumococci
dc.subjectPenicillin
dc.subjectResistant
dc.subjectMeningitis
dc.titleManaging penicillin resistant pneumococcal meningitis: an international id-iri study
dc.typeArticle

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