Document Detail


Fatal outcome from meningococcal disease--an association with meningococcal phenotype but not with reduced susceptibility to benzylpenicillin.
MedLine Citation:
PMID:  12435065     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Penicillin has been the mainstay of treatment for meningococcal disease. Isolates of Neisseria meningitidis that are less susceptible to penicillin have been reported in several countries and in recent years have become more common. The clinical significance of this reduced susceptibility has not been investigated on a large scale. Hence, N. meningitidis isolates from culture-confirmed cases of meningococcal disease in England and Wales, between 1993 and 2000, were routinely serogrouped, serotyped and tested for susceptibility to penicillin. These data were linked to death registrations and analysed retrospectively. The changing trends in susceptibility were described and multivariate logistic regression was used to examine associations between strain characteristics and fatal outcome. The frequency of N. meningitidis isolates less susceptible to penicillin increased from < 6% in 1993 to > 18% in 2000. In particular, isolates expressing serogroup C with serotype 2b and serogroup W135 had a higher frequency of reduced penicillin susceptibility (49% and 55%, respectively). There was no evidence of an association between fatal outcome and infection with a less penicillin-susceptible isolate. Fatal outcome was associated with serogroup and serotype, with the odds of death for cases infected with C:2a and B:2a strains three-fold higher when compared with the baseline. For this large dataset the serogroup and serotype of the infecting strain influenced mortality from meningococcal disease and may be markers for hypervirulence. No association was found between reduced penicillin susceptibility and fatal outcome, but the increasing frequency of isolates less susceptible to penicillin highlights the need for continued surveillance.
Authors:
Caroline L Trotter; Andrew J Fox; Mary E Ramsay; Francesca Sadler; Stephen J Gray; Richard Mallard; Edward B Kaczmarski
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of medical microbiology     Volume:  51     ISSN:  0022-2615     ISO Abbreviation:  J. Med. Microbiol.     Publication Date:  2002 Oct 
Date Detail:
Created Date:  2002-11-18     Completed Date:  2002-12-13     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0224131     Medline TA:  J Med Microbiol     Country:  England    
Other Details:
Languages:  eng     Pagination:  855-60     Citation Subset:  IM    
Affiliation:
Immunisation Division, PHLS Communicable Disease Surveillance Centre, London, UK. Ctrotter@phls.org.uk
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Child
Child, Preschool
England / epidemiology
Female
Humans
Infant
Male
Meningococcal Infections / drug therapy,  microbiology*,  mortality*
Middle Aged
Neisseria meningitidis / classification,  isolation & purification
Penicillin G / pharmacology
Penicillin Resistance
Phenotype
Serotyping
Wales / epidemiology
Chemical
Reg. No./Substance:
61-33-6/Penicillin G

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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