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JAC Advance Access published online on February 25, 2003
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkg158
© 2003 by The British Society for Antimicrobial Chemotherapy
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© 2003 The British Society for Antimicrobial Chemotherapy

Original article

Clinical features and in vitro antimicrobial susceptibilities of community-acquired Klebsiella pneumoniae meningitis in Taiwan

Ping-Yu Lee 1, Wen-Neng Chang 2, Cheng-Hsien Lu 2*, Mei-Wen Lin 1, Ben-Chung Cheng 3, Chun-Chih Chien 4, Chin-Jung Chang 5, Hsueh-Wen Chang 6

1 Department of Pharmacy, Chang Gung Memorial Hospital-Kaohsiung, 123 Ta Pei Road, Niao Sung Hsiang, Kaohsiung
2 Department of Neurology, Chang Gung Memorial Hospital-Kaohsiung, 123 Ta Pei Road, Niao Sung Hsiang, Kaohsiung
3 Department of Medicine, Chang Gung Memorial Hospital-Kaohsiung, 123 Ta Pei Road, Niao Sung Hsiang, Kaohsiung
4 Department of Clinical Pathology, Chang Gung Memorial Hospital-Kaohsiung, 123 Ta Pei Road, Niao Sung Hsiang, Kaohsiung
5 Department of Pediatric Neurology, Chang Gung Memorial Hospital-Kaohsiung, 123 Ta Pei Road, Niao Sung Hsiang, Kaohsiung
6 Department of Biological Science, National Sun Yat-Sen University, Taiwan

* Corresponding author. E-mail: chlu99{at}ms44.url.com.tw.

Received 19 August 2002 ; revised 17 October 2002 ; accepted 18 January 2003

Abstract

Twenty-seven adult patients were identified as having community-acquired Klebsiella pneumoniae meningitis. The K. pneumoniae isolates, collected from cerebrospinal fluid samples, were tested for in vitro antimicrobial susceptibilities. The prognostic factors of these 27 patients were also analysed. All of the third- and fourth-generation cephalosporins tested, as well as monobactam, carbapenem and ciprofloxacin, had good activities against the isolated K. pneumoniae strains. None of the clinical isolates was detected as being an extended-spectrum {beta}-lactamase-producing pathogen. Among the third- and fourth-generation cephalosporins, ceftizoxime, cefepime, ceftriaxone and cefotaxime had superior activities, with MIC90s about four- to eight-fold lower than those of ceftazidime and moxalactam. Mortality rates of patients classified by different antimicrobial agents were as follows: ceftazidime 38% (8/21) and cefepime 16.7% (1/6). The presence of septic shock and the initial level of consciousness at the start of appropriate antimicrobial therapy were the major determinants of survival and neurological outcomes in these 27 patients. Early diagnosis and choice of appropriate antibiotics according to antimicrobial susceptibilities may improve therapeutic outcomes.

Keywords: clinical features, in vitro antimicrobial susceptibilities, community-acquired Klebsiella pneumoniae meningitis
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