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Is vancomicin necessary in empirical treatment of community-acquired meningitis?

Abstract number: P721

Güerri R., Vallecillo G., Sánchez F., Lerma E., Solé E., Villar J., López-Colomés J.L., Perello R., Díez-Pérez A.

Introduction: Community Adquired meningitis is an important disease in our emergency departments. Empirical treatment is necessary in order to improve prognosis. National guidelines (SEIMC) include vancomicin combined with cefotaxime as first election therapy.

Objective: To study susceptibility to different antibiotics in community adquired meningitis reviewing initial empirical treatment, and determine whether the introduction of vancomycin in the empirical treatment provides some benefit

Methods: a descriptive retrospective study reviewing medical reports and microbiological cultures in patients admitted in the Emergency room of the Hospital Universitario del Mar, Barcelona (455 beds, and an area of influency of 500000 habitants) during 1 year (june 2006 to june 2007).

Results: 19 patients were admitted with community-adquired meningitis. 10 men and 9 women. Mean age 52 (range 23–78).

The most common causative organisms were S. pneumoniae 9 (47.3%), N. meningitidis 7 (36.8%) and L. monocytogenes 3 (15.9%).

Among S. pneumoniae, only 1 strains was resistant to Penicillin (Minimum inhibitory concentration (MIC) >0.1 mg/ml) but continued sensibility to cephalosporin and vancomicin. The rest of isolated strains had MIC < 0.5 mg/ml to cephalosporin group. Of N. meningitidis in 1 case was resistant to penicilin (MICs >1 mg/ml) and showed fully sensibility to cephalosporines and vancomicine. No resistance to tested antibiotics was observed in L. monocytogenes.

In the Emergency Department cefotaxime and vancomicin as empirical treatment was initiated in 11 patients (57%). Four patients died (all of them with combined treatment), from whom 3 had pneumococcical meningitis and 1 with meningococcical menigitis.

Conclusion:S. pneumoniae is the most frequent pathogen in community adquired bacterial meningitis in our population. All isolated S. pneumoniae, N. meningitidis, L. monocytogenes strains remained susceptible to currently used antibiotics in empirical treatment. Therefore, adding vancomicin as empirical treatment in community adquired meningitis does not improve any benefit, and theoretically only adds potential side effects and increased costs. However, monitoring the resistance rates in our community is necessary in order to adapt clinical guidelines.

Session Details

Date: 19/04/2008
Time: 00:00-00:00
Session name: 18th European Congress of Clinical Microbiology and Infectious Diseases
Subject:
Location: Barcelona, Spain
Presentation type:
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