Clinical outcomes of meningitis caused by Streptococcus pneumoniae in the era of antibiotic resistance

Limited data are available on clinical outcomes of meningitis due to cefota xime-nonsusceptible Streptococcus pneumoniae. We analyzed data from 109 cas es of pneumococcal meningitis in Atlanta, Baltimore, and San Antonio, which were identified through population-based active surveillance from November 1994 to April 1996. Pneumococcal isolates from 9% of the cases were resist ant to cefotaxime, and isolates from 11% had intermediate susceptibility. C hildren were more likely to have cephalosporin-nonsusceptible pneumococcal meningitis, but mortality was significantly higher among adults aged 18-64 years. Vancomycin was given upon admission to 29% of patients, and within 4 8 h of admission to 52%, Nonsusceptibility to cefotaxime was not associated with the following outcomes: increased mortality, prolonged length of hosp ital or intensive care unit (ICU) stay, requirement of intubation or oxygen , ICU care, discharge to another medical or long-term-care facility, or neu rological deficit. Empirical use of vancomycin, current prevalence of drug- resistant S. pneumoniae, and degree of nonsusceptibility to cefotaxime may have influenced these findings.