Strains of penicillin-insensitive pneumococci (PNP) are becoming more common pathogens in clinical practice. However, to date, there are few data on the clinical features, therapeutic approaches and treatment outcomes of meningitis caused by PNPP compared to penicillin-sensitive Streptococcus pneumoniae.

Canadian researchers conducted a retrospective case-control nesting study that compared cases of PNPP meningitis and penicillin-sensitive pneumococci (PPP). The study was conducted as part of a national epidemiological study on invasive pneumococcal infections - the active immunization surveillance program - IMPACT.

The IMPACT database for the period 1991-1999 was analyzed and contained information on 297 cases of meningitis in 6 medical centers in Canada. Of these, 30 cases (10.1%) were due to PNPP and 45 to PPP (control).

It was revealed that for the empirical treatment of meningitis in the study and control group in 1991-1993. vancomycin was not used, while in 1999 it was used to treat all cases caused by PIE. Third generation cephalosporins were prescribed for 93.3% of patients with confirmed infections caused by ESP, and 70% of these patients received vancomycin and / or rifampicin. Penicillin was used to treat 66.7% of meningitis cases with confirmed susceptibility of S. pneumoniae to penicillin.

It was noted that patients with PNPP infection were reliably more likely to have repeated lumbar punctures (odds ratio - OR - 4.1, p = 0.01), moreover, they followed longer intravenous antibiotic treatments (15.6 days vs 12.3 days, p = 0.04) compared to the control group. The duration of intravenous administration of antibiotics to patients with PNPP meningitis, vancomycin empirically prescribed, was 12.0 days, while in similar patients who did not receive empirical treatment with vancomycin , it was 18.5 days (p = 0.04).

The overall mortality rate in patients with pneumococcal meningitis was 5.3%. Among the surviving patients, 36.6% had neurological complications, of which 19.7% had hearing loss. Multivariate analysis has shown that PNP infection is not a risk factor for hospitalization in intensive care or the development of neurological complications.

Thus, the results of a study by Canadian scientists have shown significant changes in the tactics of treating pneumococcal meningitis in the past decade. In this case, the treatment of the disease with suspected or proven insensitivity of the pathogen to penicillin is significantly different from the treatment of cases due to PPP. Due to the proliferation of penicillin-insensitive strains of S.pneumoniae, the timely microbiological diagnosis of meningitis caused by PNP is particularly important.