Emergence of Ceftriaxone Resistance during a Case of Pneumococcal Meningitis with Fatal Evolution

We report a case of a 62-year-old man treated for meningitis by ceftriaxone and dexamethasone. After neurological improvement, neurological degradation by vasculitis occurred, despite effective concentrations of ceftriaxone in the serum and cerebrospinal fluid (CSF). with increased MICs to third-gen...

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Veröffentlicht in:	Antimicrobial agents and chemotherapy 2020-02, Vol.64 (3)
Hauptverfasser:	Mizrahi, A, Marvaud, J C, Pilmis, B, Nguyen Van, J C, Couzigou, C, Bruel, C, Engrand, N, Le Monnier, A, Lambert, T
Format:	Artikel
Sprache:	eng
Schlagworte:	Bacteriology Ceftriaxone - blood Ceftriaxone - pharmacokinetics Ceftriaxone - therapeutic use Cephalosporins - blood Cephalosporins - pharmacokinetics Cephalosporins - therapeutic use Challenging Clinical Case in Antimicrobial Resistance Dexamethasone - blood Dexamethasone - pharmacokinetics Dexamethasone - therapeutic use Ecology, environment Editor's Pick Health Human health and pathology Humans Infectious diseases Life Sciences Male Meningitis, Pneumococcal - blood Meningitis, Pneumococcal - drug therapy Meningitis, Pneumococcal - metabolism Microbial Sensitivity Tests Microbiology and Parasitology Middle Aged Penicillin-Binding Proteins - genetics Penicillin-Binding Proteins - metabolism Santé publique et épidémiologie Streptococcus pneumoniae - drug effects Streptococcus pneumoniae - pathogenicity Virology
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Zusammenfassung:	We report a case of a 62-year-old man treated for meningitis by ceftriaxone and dexamethasone. After neurological improvement, neurological degradation by vasculitis occurred, despite effective concentrations of ceftriaxone in the serum and cerebrospinal fluid (CSF). with increased MICs to third-generation-cephalosporins (3GC) was isolated from the ventricular fluid 10 days after the isolation of the first strain. Isolate analysis showed that a mutation in the penicillin-binding protein 2X (PBP2X) has occurred under treatment.
ISSN:	0066-4804 1098-6596
DOI:	10.1128/AAC.01958-19