Managing penicillin resistant pneumococcal meningitis: an international id-iri study

Erdem H. Dogan E. Ankarali H. Dragovac G. Seyman D. Tarakci A. Dalmanoglu E. Kaya-Kalem A. Batirel A. Senbayrak S. Cvetanovska M. Kazancioglu S. Pekok A.U. Rahimi B.A. Uguz M. Ala-Selek S. Cagatay A. Demir-Tekol S. Kul H. Kuruoglu T. Temocin F. Alkan S. Arikan F.B. Aslan T. Tasbakan M. Altun-Demircan S. Damar-Cakirca T. El-Kholy A. Kahraman H. Kalchev Y. Kulzhanova S. Líšková A. Oncu S. Özdemir M. Özer D. Cuvalci N.Ö. Simsek-Bozok T. Catalina L.M. Miftode E. Miftode L. Murdjeva M. Onyeaghala C. Sivrikaya B.B. Ozer-Kokkizil S. Yalci A. Yapici O. Zajkowska J. Fasciana T.
November 2025 Springer Science and Business Media Deutschland GmbH

European Journal of Clinical Microbiology and Infectious Diseases
2025 #44 Issue 11 2855 - 2866 pp.

Penicillin-resistant pneumococcal meningitis (PRPM) is a challenging and fatal infection. We conducted a multicentre international retrospective study to evaluate the clinical features, outcomes, predictors of outcomes antimicrobial efficacy and drug susceptibility in patients with PRPM. The study, conducted through the “Infectious Diseases–International Research Initiative” across 33 centers in 11 countries, analyzed PRPM patients treated between 2019 and 2024 using univariate and multivariate analyses. A total of 138 patients were included. Of these, 83 (60.1%) were fully cured, 27 (19.6%) died, and 28 (20.3%) survived with sequelae. Mortality was associated with ICU admission (OR 14.886; p = 0.021), mechanical ventilation (OR 7.205; p = 0.049), and vasopressor use (OR 8.983; p = 0.025). Higher CSF leukocyte count (OR 0.854; p = 0.060) and blood leukocyte count (OR 0.283; p = 0.021) were linked to lower mortality risk. Patients who developed sequelae were more likely to require mechanical ventilation (OR 9.354; p = 0.001), experience recurrent meningitis (OR 5.562; p = 0.081), and have lower platelet counts (OR 0.001; p = 0.050), compared to those who fully recovered. Sequelae patients had higher GCS scores (OR 1.365; p = 0.014), more corticosteroid use (OR 5.301; p = 0.061), and less vasopressor use (OR 0.205; p = 0.019) compared to those who died. The antibiotic susceptibility profiles of the isolates in our PRSP cohort were: Ceftriaxone (75/134, 55.9%), meropenem (26/44, 59%), moxifloxacin (47/48, 97.9%). PRPM is a fatal disease in which mortality and sequelae occurring in two-fifths of cases. Severe illness markers such as ICU admission, mechanical ventilation, and vasopressor use, along with recurrent meningitis are linked to worse outcomes. Thrombocytopenia, low leukocyte counts, and lower GCS scores are indicators of poor prognosis, while corticosteroid therapy appears protective in PRPM. Therapeutic optimization is challenged by rising resistance and pharmacokinetic limitations, though moxifloxacin shows the highest susceptibility; further research is warranted.

Meningitis , Penicillin , Pneumococci , Resistant , Streptococcus pneumoniae

Text of the article Перейти на текст статьи

Department of Infectious Diseases & Clinical Microbiology, Health Sciences University, Gülhane School of Medicine, Ankara, Turkey
Department of Biostatistics and Medical Informatics, Istanbul Medeniyet University Faculty of Medicine, Istanbul, Turkey
University of Novi Sad, Faculty of Medicine, RS, Novi Sad, Serbia
Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Antalya Training and Research Hospital, Antalya, Turkey
Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Konya City Hospital, Konya, Turkey
Department of Infectious Diseases and Clinical Microbiology, Balıkesir University, Faculty of Medicine, Balıkesir, Turkey
Department of Infectious Diseases & Clinical Microbiology, Yildirim Beyazit University, Bilkent City Hospital, Ankara, Turkey
Department of Infectious Diseases & Clinical Microbiology, Health Sciences University, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey
Department of Infectious Diseases & Clinical Microbiology, Health Sciences University, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
Clinic for Infectious Diseases, Skopje, North Macedonia
Department of Infectious Diseases and Clinical Microbiology, Pendik Medical Park Hospital, Istanbul, Turkey
Department of Infectious Diseases, Kandahar University Medical Faculty, Teaching Hospital, Kandahar, Afghanistan
Department of Infectious Diseases and Clinical Microbiology, Mersin City Hospital, Mersin, Turkey
Department of Infectious Diseases & Clinical Microbiology, Bagcilar Training and Research Hospital, Istanbul, Turkey
Department of Infectious Diseases and Clinical Microbiology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
Department of Neurosurgery, Ankara Yildirim Beyazit University, Ankara Bilkent City Hospita, Ankara, Turkey
Ondokuz Mayis University, Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Samsun, Turkey
Department of Infectious Diseases and Clinical Microbiology, Onsekiz Mart University, School of Medicine, Canakkale, Turkey
Department of Infectious Diseases and Clinical Microbiology, Ege University, School of Medicine, Izmir, Turkey
Department of Infectious Diseases and Clinical Microbiology, Bezmialem University, School of Medicine, Izmir, Turkey
Department of Infectious Diseases and Clinical Microbiology, Ankara Training & Research Hospital, Istanbul, Turkey
Department of Infectious Diseases and Clinical Microbiology, Sanliurfa Training and Research Hospita, Ankara, Turkey
Department of Clinical Pathology, Cairo University, Faculty of Medicine, Cairo, Egypt
Department of Infectious Diseases and Clinical Microbiology, Osmangazi University, School of Medicine, Giza, Turkey
Department of Medical Microbiology and Immunology and Research Institute, St. George University Hospital, Plovdiv, Bulgaria
Department of Infectious Diseases, Astana Medical University, Astana, Kazakhstan
Faculty Hospital Nitra, Clinical Microbiology Institute, St. Elisabeth University of Health Care and Social Work, Bratislava, Slovakia
Department of Infectious Diseases and Clinical Microbiology, Adnan Menderes University, School of Medicine, Aydin, Turkey
Department of Microbiology, Necmettin Erbakan University, School of Medicine, Konya, Turkey
Department of Infectious Diseases and Clinical Microbiology, Celal Bayar University, School of Medicine, Manisa, Turkey
Department of Infectious Diseases and Clinical Microbiology, Mersin University, School of Medicine, Mersin, Turkey
St. Parascheva Clinical Hospital of Infectious Diseases, Iasi, Romania
Department of Internal Medicine, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
Department of Infectious Dsieases and Clinical Microbiology, Samsun University, Training and Research Hospital, Samsun, Turkey
Department of Infectious Diseases and Clinical Microbiology, Manisa City Hospital, Manisa, Turkey
Department of Infectious Diseases and Neuroinfections, Medical University in Białystok, Białystok, Poland
Department of Health Promotion, Maternal Childhood, Internal Medicine of Excellence G. D’Alessandro, University of Palermo, Palermo, Italy

Department of Infectious Diseases & Clinical Microbiology
Department of Biostatistics and Medical Informatics
University of Novi Sad
Department of Infectious Diseases and Clinical Microbiology
Department of Infectious Diseases and Clinical Microbiology
Department of Infectious Diseases and Clinical Microbiology
Department of Infectious Diseases & Clinical Microbiology
Department of Infectious Diseases & Clinical Microbiology
Department of Infectious Diseases & Clinical Microbiology
Clinic for Infectious Diseases
Department of Infectious Diseases and Clinical Microbiology
Department of Infectious Diseases
Department of Infectious Diseases and Clinical Microbiology
Department of Infectious Diseases & Clinical Microbiology
Department of Infectious Diseases and Clinical Microbiology
Department of Neurosurgery
Ondokuz Mayis University
Department of Infectious Diseases and Clinical Microbiology
Department of Infectious Diseases and Clinical Microbiology
Department of Infectious Diseases and Clinical Microbiology
Department of Infectious Diseases and Clinical Microbiology
Department of Infectious Diseases and Clinical Microbiology
Department of Clinical Pathology
Department of Infectious Diseases and Clinical Microbiology
Department of Medical Microbiology and Immunology and Research Institute
Department of Infectious Diseases
Faculty Hospital Nitra
Department of Infectious Diseases and Clinical Microbiology
Department of Microbiology
Department of Infectious Diseases and Clinical Microbiology
Department of Infectious Diseases and Clinical Microbiology
St. Parascheva Clinical Hospital of Infectious Diseases
Department of Internal Medicine
Department of Infectious Dsieases and Clinical Microbiology
Department of Infectious Diseases and Clinical Microbiology
Department of Infectious Diseases and Neuroinfections
Department of Health Promotion

10 лет помогаем публиковать статьи Международный издатель

Книга Публикация научной статьи Волощук 2026 Book Publication of a scientific article 2026