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Outcomes of adults with invasive meningococcal disease with reduced penicillin susceptibility in Auckland 2004–2017

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Abstract

Purpose

The purpose of this study was to assess the clinical outcomes of adults with invasive meningococcal disease (IMD) and to compare the outcomes of patients with IMD caused by a penicillin susceptible isolate (minimum inhibitory concentration (MIC) ≤ 0.06 mg/L) with patients with IMD caused by an isolate with reduced penicillin susceptibility (MIC > 0.06 mg/L). We also assessed the outcomes of patients with IMD caused by an isolate with reduced penicillin susceptibility who were treated exclusively with intravenous (IV) benzylpenicillin.

Methods

Retrospective study of all culture positive IMD in adult patients (age ≥ 15 years) in the Auckland region from 2004 to 2017.

Results

One hundred and thirty-nine patients were included; 94 had penicillin susceptible isolates (88 cured, 6 died), and 45 had an isolate with reduced penicillin susceptibility (41 cured, 1 possible relapse, 3 died). The median benzylpenicillin/ceftriaxone treatment duration was 3 days for both groups. There was no difference in the patient outcomes of both groups. Eighteen patients with IMD caused by an isolate with reduced penicillin susceptibility received benzylpenicillin alone and were cured.

Conclusions

This study provides further support to existing data that has shown that short duration IV beta-lactam treatment is effective for IMD in adults. Only a small number of patients with meningitis caused by an isolate with reduced penicillin susceptibility received benzylpenicillin alone, limiting its evaluation. For Neisseria meningitidis meningitis, we recommend ceftriaxone as empiric treatment and as definitive treatment when this is caused by an isolate with reduced penicillin susceptibility.

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References

  1. Martin D, Lopez L. The epidemiology of meningococcal disease in New Zealand in 2008. Porirua: Institute of Environmental Science Research; 2009.

    Google Scholar 

  2. The Institute of Environmental Science and Research Ltd (ESR). Notifiable diseases in New Zealand: annual report 2018. Poirura: ESR; 2020.

    Google Scholar 

  3. Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing 28th ed. Wayne: CLSI; 2018.

    Google Scholar 

  4. The European committee on antimicrobial susceptibility testing. Breakpoint tables for interpretation of MICs and zone diameters. Version 10.0. 2020. p. Version 10.0. http://www.eucast.org

  5. Martin D, McDowell R, Garrett N, Baker M. The epidemiology of meningococcal disease in New Zealand in 2001. Porirua: Institute of Environmental Science and Research; 2002.

    Google Scholar 

  6. Institute of Environmental Science and Research (ESR). Antimicrobial susceptibility of invasive neisseria meningitidis, 2017. Porirua: ESR; 2018.

    Google Scholar 

  7. Sáez-Nieto JA, Fontanals D, de Jalon JG, de Artola VM, Peña P, Morera MA, et al. Isolation of neisseria meningitidis strains with increase of penicillin minimal inhibitory concentrations. Epidemiol Infect. 1987;99:463–9.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Pérez-Trallero E, Aldamiz-Echeverria L, Pérez-Yarza E. Meningococci with increased resistance to penicillin. Lancet. 1990;335:1096.

    Article  PubMed  Google Scholar 

  9. Turner P, Southern K, Spencer N, Pullen H. Treatment failure in meningococcal meningitis. Lancet. 1990;335:732–3.

    Article  CAS  PubMed  Google Scholar 

  10. Vincent JL, Moreno R, Takala J, Willatts S, De Mendonça A, Bruining H, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the working group on sepsis-related problems of the European society of intensive care medicine. Intensive Care Med. 1996;22:707–10.

    Article  CAS  PubMed  Google Scholar 

  11. Trotter CL, Chandra M, Cano R, Larrauri A, Ramsay ME, Brehony C, et al. A surveillance network for meningococcal disease in Europe. FEMS Microbiol Rev. 2007;31:27–36.

    Article  CAS  PubMed  Google Scholar 

  12. Pace D, Pollard AJ. Meningococcal disease: clinical presentation and sequelae. Vaccine. 2012;30:B3-9.

    Article  PubMed  Google Scholar 

  13. Dwilow R, Fanella S. Invasive meningococcal disease in the 21st century. An update for the clinician. Curr Neurol Neurosci Rep. 2015. https://doi.org/10.1007/s11910-015-0524-6.

    Article  PubMed  Google Scholar 

  14. Cabellos C, Pelegrín I, Benavent E, Gudiol F, Tubau F, Garcia-Somoza D, et al. Invasive meningococcal disease: impact of short course therapy. A DOOR/RADAR study. J Infect. 2017;75:420–5. https://doi.org/10.1016/j.jinf.2017.08.009.

    Article  PubMed  Google Scholar 

  15. Trotter CL, Fox AJ, Ramsay ME, Sadler F, Gray SJ, Mallard R, et al. Fatal outcome from meningococcal disease—An association with meningococcal phenotype but not with reduced susceptibility to benzylpenicillin. J Med Microbiol. 2002;51:855–60.

    Article  CAS  PubMed  Google Scholar 

  16. Ellis-Pegler R, Galler L, Roberts S, Thomas M, Woodhouse A. Three days of intravenous benzyl penicillin treatment of meningococcal disease in adults. Clin Infect Dis. 2003;37:658–62.

    Article  CAS  PubMed  Google Scholar 

  17. Briggs S, Ellis-Pegler R, Roberts S, Thomas M, Woodhouse A. Short course intravenous benzylpenicillin treatment of adults with meningococcal disease. Intern Med J. 2004;34:383–7.

    Article  CAS  PubMed  Google Scholar 

  18. Viladrich PF, Pallares R, Ariza J, Rufi G, Gudiol F. Four days of penicillin therapy for meningococcal meningitis. Arch Intern Med. 1986;146:2380–2.

    Article  CAS  PubMed  Google Scholar 

  19. Martin E, Guggi T, Hohl P, Fernex M, Kayser FH. Short course single daily ceftriaxone monotherapy for acute bacterial meningitis in children: results of a Swiss multicenter study. Part I: clinical results. Infection. 1990;18:70–7.

    Article  CAS  PubMed  Google Scholar 

  20. van de Beek D, Cabellos C, Dzupova O, Esposito S, Klein M, Kloek AT, et al. ESCMID guideline: diagnosis and treatment of acute bacterial meningitis. Clin Microbiol Infect. 2016;22:S37-62.

    Article  PubMed  Google Scholar 

  21. Masson-Behar V, Jacquier H, Richette P, Ziza JM, Zeller V, Rioux C, et al. Arthritis secondary to meningococcal disease: a case series of 7 patients. Medicine. 2017. https://doi.org/10.1097/MD.0000000000007573.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Schaad UB. Arthritis in disease due to Neisseria meningitidis. Rev Infect Dis. 1980;2:880–8.

    Article  CAS  PubMed  Google Scholar 

  23. Institute of Environmental Science and Research (ESR). Antimicrobial susceptibility of invasive neisseria meningitidis, 2018. Porirua: ESR; 2019.

    Google Scholar 

  24. Burgess DS, Frei CR, Lewis JS, Fiebelkorn KR, Jorgensen JH. The contribution of pharmacokinetic-pharmacodynamic modelling with Monte Carlo simulation to the development of susceptibility breakpoints for Neisseria meningitidis. Clin Microbiol Infect. 2007;13:33–9.

    Article  CAS  PubMed  Google Scholar 

  25. Nasrin D, Collignon PJ, Roberts L, Wilson EJ, Pilotto LS, Douglas RM. Effect of beta lactam antibiotic use in children on pneumococcal resistance to penicillin: prospective cohort study. BMJ. 2002 Jan 5;324:28–28.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Whyler N, Tomlin A, Tilyard M, Thomas M. Ethnic disparities in community antibacterial dispensing in New Zealand, 2015. N Z Med J. 2018 Aug 17;131:50–60.

    PubMed  Google Scholar 

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Funding

A payment of $2000 (USD) was received from the University of Gothenburg, Sweden, to cover the costs of supervision of two elective medical students (SS and MHH).

Author information

Author notes

  1. Matthew Broom

    Present address: North Shore Hospital Infectious Diseases Department, Waitemata District Health Board, 124 Shakespeare Road, Takapuna, Auckland, 0620, New Zealand

  2. Sara Svensson

    Present address: Norra Ӓlvsborgs Lӓnssjukhus, Lӓrketorpsvӓgen, 461 73, Trollhӓttan, Sweden

  3. Maria Hansen Hygstedt

    Present address: , Ӧgonkliniken, Lansmansgatan 20, 431 30, Molndal, Sweden

Authors and Affiliations

  1. Auckland City Hospital Infectious Diseases Department, Auckland District Health Board, 2 Park Road, Grafton, Auckland, 1023, New Zealand

    Matthew Broom, Sara Svensson, Maria Hansen Hygstedt, Mark Thomas & Simon Briggs

  2. North Shore Hospital Infectious Diseases Department, Waitemata District Health Board, 124 Shakespeare Road, Takapuna, Auckland, 0620, New Zealand

    Nick Gow

  3. Starship Hospital Infectious Diseases Department, Auckland District Health Board, 2 Park Road, Grafton, Auckland, 1023, New Zealand

    Emma Best

  4. Department of Paediatrics, University of Auckland, Level 12, Support Building Auckland City Hospital, 2 Park Road, Grafton, Auckland, 1023, New Zealand

    Emma Best

  5. The Institute of Environmental Science and Research, 34 Kenepuru Drive, Kenepuru, Porirua, New Zealand

    Helen Heffernan

  6. University of Gothenburg, 405 30, Gothenburg, Sweden

    Sara Svensson & Maria Hansen Hygstedt

  7. Middlemore Hospital Kidz First Infectious Diseases Department, Counties Manukau District Health Board, 100 Hospital Road, Middlemore, Auckland, 2025, New Zealand

    Rachel Webb

  8. Middlemore Hospital Infectious Diseases Department, Counties Manukau District Health Board, 100 Hospital Road, Middlemore, Auckland, 2025, New Zealand

    David Holland

  9. Department of Molecular Medicine, University of Auckland, Grafton Campus, Grafton, Auckland, 1023, New Zealand

    Mark Thomas

Authors
  1. Matthew Broom
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  2. Emma Best
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  3. Helen Heffernan
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  4. Sara Svensson
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  9. Mark Thomas
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  10. Simon Briggs
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Corresponding author

Correspondence to Matthew Broom.

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Broom, M., Best, E., Heffernan, H. et al. Outcomes of adults with invasive meningococcal disease with reduced penicillin susceptibility in Auckland 2004–2017. Infection 51, 425–432 (2023). https://doi.org/10.1007/s15010-022-01897-6

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  • DOI: https://doi.org/10.1007/s15010-022-01897-6

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