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

Antimicrob Agents Chemother. 2020 Feb 21;64(3):e01958-19. doi: 10.1128/AAC.01958-19. Print 2020 Feb 21.

Abstract

We report a case of a 62-year-old man treated for Streptococcus pneumoniae 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). S. pneumoniae 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.

Keywords: 3GC resistance; Streptococcus pneumoniae; meningitis; meningitis-related delayed cerebral injury; penicillin-binding protein; treatment failure.

Publication types

  • Case Reports

MeSH terms

  • Ceftriaxone / blood
  • Ceftriaxone / pharmacokinetics
  • Ceftriaxone / therapeutic use*
  • Cephalosporins / blood
  • Cephalosporins / pharmacokinetics
  • Cephalosporins / therapeutic use
  • Dexamethasone / blood
  • Dexamethasone / pharmacokinetics
  • Dexamethasone / therapeutic use
  • Humans
  • Male
  • Meningitis, Pneumococcal / blood
  • Meningitis, Pneumococcal / drug therapy*
  • Meningitis, Pneumococcal / metabolism
  • Microbial Sensitivity Tests
  • Middle Aged
  • Penicillin-Binding Proteins / genetics
  • Penicillin-Binding Proteins / metabolism
  • Streptococcus pneumoniae / drug effects
  • Streptococcus pneumoniae / pathogenicity

Substances

  • Cephalosporins
  • Penicillin-Binding Proteins
  • PBP 2x protein, Streptococcus
  • Ceftriaxone
  • Dexamethasone