What is the prevalence of penicillin resistance among Streptococcus pneumoniae (pneumococcal) strains that cause meningitis?

Updated: Jul 16, 2019
  • Author: Rodrigo Hasbun, MD, MPH; Chief Editor: Michael Stuart Bronze, MD  more...
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Bacterial resistance, especially penicillin resistance among S pneumoniae strains, has been increasing worldwide. In March 2008, the US Food and Drug Administration (FDA) revised the susceptibility breakpoints for penicillin versus S pneumoniae. For nonmeningeal infections, the breakpoints are as follows:

  • < 2 µg/mL – Susceptible

  • 4 µg/mL – Intermediate

  • >8 µg/mL – Resistant

For meningitis, the breakpoints are as follows:

  • < 0.06 µg/mL – Susceptible

  • ≥0.12 µg/mL – Resistant

With the new meningitis criteria (≥0.12 μg/mL), the prevalence of resistance was 34.8% in 2008, whereas with the old criteria (≥2 μg/mL), it was 12.3% for CSF. [34] The geographic distribution of this resistance is variable, and it is important to know the regional patterns when deciding on local empiric antibiotic therapy (see Medication). A large observational study of 548 pneumococcal meningitis cases from Brazil showed that penicillin resistance was associated with higher mortality even after adjustment for age and severity of illness. [35]

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