044 - FORTY YEARS OF ADULT PNEUMOCOCCAL MENINGITIS. BARCELONA 1979-2018 (ID 348)
Abstract
Background
Among diseases caused by Streptococcus pneumoniae, the pneumococcal meningitis is associated with the highest morbidity and mortality rates. In this study, we analysed the adult pneumococcal meningitis over a 40-year period.
Methods
Pneumococcal meningitis episodes and clinical data were prospectively collected at Hospital Universitari de Bellvitge. Strains were serotyped and antimicrobial susceptibility was performed following EUCAST criteria. For analysis purposes four periods were defined: 1979-1988, 1989-1998, 1999-2008 and 2009-2018.
Results
A total of 263 pneumococcal meningitis episodes were collected: 77, 51, 63 and 72, respectively. After the increase in the 90’s, the rate of penicillin and cefotaxime resistance decreased; 23.4% to 41.2% to 30.2% to 26.4% (penicillin) and 3.9% to 23.5% to 17.5% to 4.2% (cefotaxime). This decrease was also observed in fatality rates (24.7% to 15.7% to 12.7% to 8.3%). The most common foci and associated serotypes were: acute otitis media (AOM) (38.4%) and serotypes 3, 19A and 19F; cerebrospinal fluid fistula (31.2%) and serotypes 6B, 9V and 3; and hematogenous seeding (24.7%) and serotypes 8, 10A and 4. The greatest fatality rate was in hematogenous focus (36.9%) followed by AOM (9.9%) and fistula (9.7%). On the other hand, penicillin and cefotaxime resistance rates by foci were fistula (32.9% and 11.0%), AOM (26.7% and 10.9%) and haematogenous focus (29.2% and 10.8%).
Conclusions
Over the last four decades, penicillin and cefotaxime resistance-rate decreased as well as fatality rates. These reductions were linked to the introduction of pneumococcal conjugate vaccines, along with the adjuvant use of dexamethasone. Pneumococcal meningitis focus determines serotype and mortality.
