A new twist on an old problem. A case of pediatric meningitis caused by multidrug-resistant Streptococcus pneumoniae serotype 19 A.

Recent studies show that multidrug-resistant Streptococcus pneumoniae serotype 19A continues to emerge as a cause of invasive pneumococcal disease after the introduction of Prevnar®. We report a case of multidrug-resistant S. pneumoniae serotype 19A meningitis successfully treated with vancomycin and levofl oxacin. This case reinforces the need for the empiric use of vancomycin in meningitis and the need for alternative treatments.

[1]  Susan M. Poutanen.  Emergence of Serotype 19A Multi-Drug Resistant S. pneumoniae (MDR SPN) in Canada , 2008 .

[2]  W. Schaffner,et al.  Population snapshot of emergent Streptococcus pneumoniae serotype 19A in the United States, 2005. , 2008, The Journal of infectious diseases.

[3]  W. Schaffner,et al.  Incidence of pneumococcal disease due to non-pneumococcal conjugate vaccine (PCV7) serotypes in the United States during the era of widespread PCV7 vaccination, 1998-2004. , 2007, The Journal of infectious diseases.

[4]  M. Pichichero,et al.  Emergence of a multiresistant serotype 19A pneumococcal strain not included in the 7-valent conjugate vaccine as an otopathogen in children. , 2007, JAMA.

[5]  S. Lockhart,et al.  Phase 1 trial of a 13-valent pneumococcal conjugate vaccine in healthy adults. , 2007, Vaccine.

[6]  D. Rasko,et al.  Impact of the Pneumococcal Conjugate Vaccine on Serotype Distribution and Antimicrobial Resistance of Invasive Streptococcus pneumoniae Isolates in Dallas, TX, Children From 1999 Through 2005 , 2007, The Pediatric infectious disease journal.

[7]  Emergence of antimicrobial-resistant serotype 19A Streptococcus pneumoniae--Massachusetts, 2001-2006. , 2007, MMWR. Morbidity and mortality weekly report.

[8]  W. Schaffner,et al.  Effect of introduction of the pneumococcal conjugate vaccine on drug-resistant Streptococcus pneumoniae. , 2006, The New England journal of medicine.

[9]  Incidence of invasive pneumococcal disease after introduction of the Universal Infant Immunization Program, British Columbia (2002-2005). , 2006, Canada communicable disease report = Releve des maladies transmissibles au Canada.

[10]  C. Whitney,et al.  Postvaccine genetic structure of Streptococcus pneumoniae serotype 19A from children in the United States. , 2005, The Journal of infectious diseases.

[11]  S. Obaro,et al.  Efficacy of nine-valent pneumococcal conjugate vaccine against pneumonia and invasive pneumococcal disease in The Gambia: randomised, double-blind, placebo-controlled trial , 2005, The Lancet.

[12]  Allan R Tunkel,et al.  Practice guidelines for the management of bacterial meningitis. , 2004, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[13]  G. Mccracken.  Pharmacodynamics of gatifloxacin in experimental models of pneumococcal meningitis. , 2000, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[14]  G. Mccracken,et al.  Antibiotic pharmacodynamics in cerebrospinal fluid. , 1998, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.