Pseudomonas stutzeri infection presenting as delayed-onset adult bacterial meningitis in two post-neurosurgery patients: A case report

Abstract

Introduction Pseudomonas infection in the central nervous system is generally uncommon. Much rarer is a non-Pseudomonas aeruginosa infection presenting as adult bacterial meningitis. Indolent cause of meningitis documented to date were Propionibacterium acnes with a median time of 300 days, and the more common P. aeruginosa had median lag time of 20 days. P. stutzeri was documented to cause delayed-onset endophthalmitis after four years post-operatively. This report presented two post-neurosurgery patients presenting with fever and headache with no nuchal rigidity years after. Cerebrospinal fluid cultures identified a P. stutzeri isolate and the patients were treated as meningitis. Upon extensive literature search, no reports have been made on P. stutzeri presenting as an indolent infection in the central nervous system. Objective To identify the clinical implication and drug susceptibility of isolating Pseudomonas stutzeri in post-neurosurgery patients. Result and analysis Empiric treatment with Ceftriaxone then shifted to Meropenem after culture and sensitivity testing was given. Antibiotic therapy was continued for fourteen days with clinical improvement and documented eradication of the organism. Conclusion Prudent antibiotic use based on culture and sensitivity tests is crucial. Though infection with Pseudomonas stutzeri has considerably low mortality rate and the number of reported cases is very limited worldwide, the number of neurosurgical procedures are increasing everyday, hence, there is a need to establish reports on central nervous system infections related to non-Pseudomonas aeruginosa organisms to recognize its potential risks and establish protocols to prevent post-surgical infections.