Meningitis is an infectious syndrome caused by bacteria, viruses, fungi and noninfectious agents. Bacterial etiology usually presents as a more severe condition, and the main bacteria involved are S. pneumoniae and N. meningitidis. The objective of this study is to describe the epidemiological profile of hospitalizations for pneumococcal meningitis and the susceptibility profile of pneumococcus in cerebrospinal fluid (CSF) samples between 2020 and 2024. Descriptive, retrospective analysis in a university hospital that is a reference center for infectious diseases. CSF samples from patients hospitalized with pneumococcal meningitis were analyzed. Over the study period, 17 patients were hospitalized with microbiologically confirmed meningitis caused by S. pneumoniae. Males accounted for 59% and females 41% of hospitalizations. Median age was 28 years. All cases had positive CSF cultures performed by the State Central Public Health Laboratory (LACEN). Antimicrobial susceptibility testing showed ceftriaxone resistance in 25% (6/8) of pneumococcal isolates, and no resistance to vancomycin was found. In 70% of samples, S. pneumoniae was also detected by real-time polymerase chain reaction (PCR). The main serotypes identified were 3 (12%) and 6C (12%). Hospital discharge occurred in 70% of hospitalized patients (12/17), and the case-fatality rate was 29.4% (5/17). Pneumococcal meningitis is a severe infection that must be diagnosed and treated rapidly. Ceftriaxone resistance was found in 25% of the isolates analyzed, and despite the small number of cases, this already suggests a higher resistance of pneumococcus to third-generation cephalosporins compared with the resistance reported at the national level (17.6%) in 2024. Thus, the data highlight the importance of discussing and re-evaluating the empirical use of third-generation cephalosporins as first-line therapy for meningitis caused by S. pneumoniae.
Santos et al. (Sun,) studied this question.
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