Nosocomial Bacterial Meningitis Research Articles

Clinical characteristics and outcomes of acute bacterial meningitis in adults at a tertiary university hospital in Thailand.

The epidemiology of acute bacterial meningitis varies among settings, areas, and times. This study aimed to determine the clinical characteristics, the causative organisms and their antibiotic susceptibility, and the outcomes of patients with acute bacterial meningitis in Thai adults. This retrospective study included hospitalized patients aged ≥18 years diagnosed with acute bacterial meningitis at Siriraj Hospital during January 2002-December 2016. Of 390 patients, the median age was 48 years, 51% were male, and 80% had at least 1 underlying illness. Over half (54%) of patients had community-acquired bacterial meningitis (CBM), and 46% had nosocomial bacterial meningitis (NBM). The triad of acute bacterial meningitis (fever, headache, and neck stiffness) was found in 46% of CBM and 15% of NBM (P < .001). The causative organisms were identified in about half (53%) of patients. Most study patients (73%) received antibiotic treatment before the CSF collection. Causative organisms were identified more frequently in CBM (P < .001). Gram-positive cocci were more prevalent in CBM (P < .001), whereas Gram-negative bacilli were more common in NBM (P < .001). Streptococcus agalactiae (29%), Streptococcus pneumoniae (12%), and Streptococcus suis (11%) were most common in CBM, and all of them were sensitive to third-generation cephalosporins. Acinetobacter baumannii (19%), Klebsiella pneumoniae (16%), and Staphylococcus aureus (11%) were the most common organisms in NBM, and antibiotic-resistant isolates were frequently found among these organisms. Ceftriaxone monotherapy and meropenem plus vancomycin were the most common empiric antibiotic in CBM and NBM, respectively. Mortality was 19% among CBM and 23% among NBM (P = .338). HIV infection, alcoholism, pneumonia, shock, and disseminated intravascular coagulation were independent predictors of mortality. Mortality remains high among adults with acute bacterial meningitis in Thailand. A clinical practice guideline for acute bacterial meningitis should be developed that is based on local epidemiology and microbiology data.

Diagnostic Accuracy of Cerebrospinal Fluid Presepsin as a Marker of Bacterial Meningitis in Patients with External Ventricular Drainage – A Cross-Sectional Study in a Tertiary Intensive Care Unit

Background: External ventricular drainage (EVD)-related meningitis is one of the most dreaded nosocomial infections, causing severe neurological sequelae leading to high morbidity and mortality. Blood-contaminated cerebra spinal fluid (CSF) hinders prompt diagnosis and, thus, treatment of such infections. In this study, we aim to establish the usefulness of CSF presepsin as a marker of nosocomial bacterial meningitis in suspected patients with EVD against other CSF markers. Methodology: We conducted a cross-sectional study by enrolling all neurosurgical patients with EVD during a 10-month study period. Patients were divided into two groups: the test arm of already-diagnosed bacterial meningitis cases versus the control arm of aseptic meningitis cases. Presepsin in CSF was measured along with other CSF markers such as total leukocyte count, percentage of neutrophils and lymphocytes, glucose, protein, multiplex and polymerase chain reaction test, and cultures were analyzed for both the groups. Results: A total of 33 adult patients with EVD were analyzed during the study period: 18 cases were in the test arm group, and 15 were in the control arm group. Compared with all the measured parameters, CSF presepsin, with a cutoff value of 300 pg/ml, was the only marker that could differentiate between the groups with a diagnostic accuracy of 0.817, with a sensitivity of 84.2%, and a specificity of 82.1%. Conclusion: Presepsin in CSF is a reliable diagnostic marker of bacterial meningitis in suspected patients with EVD.

Bacterial and prognostic profile of nosocomial meningitis in newborns

Introduction: Nosocomial neonatal meningitis is particularly dreadful because it occurs in patients of immature immunity and a developing brain. It is always a challenge for the clinician due to its clinical polymorphism making the diagnosis often difficult Aim: To study the epidemiological, clinical, bacteriological, therapeutic and evolutionary aspects of neonatal nosocomial bacterial meningitis. Results: Through our series, we reported fourteen cases of nosocomial meningitis, ie 43% of meningitis recorded over the study period. A male predominance was observed in 57.1%. The newborns were preterm in 28% of cases and had low birth weight in 42% of cases. The germ isolated was Klebsiella pneumoniae in 28.4% of cases. The blood culture was positive in 64% of cases. The same germ was isolated in both blood and the cerebrospinal fluid in 42% of cases. The complications found were: ventriculitis (28.5%), triventricular and tetraventricular hydrocephalus (14.2%) and multiple cerebral abscesses (14.2%). The mortality rate recorded in our series was 28.5%. Conclusion: Nosocomial meningitis is a serious or even fatal condition requiring early diagnosis and adequate antimacrobial therapy. Prevention remains the best strategy for the battle against this infection

Characteristics of Post-Neurosurgical Nosocomial Bacterial Meningitis in Adults: a retrospective Cross-Sectional Study

Aim: To analyze the characteristics of Post-neurosurgical nosocomial bacterial meningitis in adults Study design: A retrospective cross-sectional study Place and duration: Riyadh Care Hospital/ National Care Hospital, from July 2005 to June 2010 then 2013 to 2018. Methodology: Over ten years, sixty-two patients above the age of 16 years who suffered from Post-neurosurgical nosocomial bacterial meningitis were evaluated by collecting clinical data. The cases were divided into two categories, the first one from July 2007 to June 2012 and second one from August 2013 to July 2018. Results: Among the 62 patients, there were 43 males and 19 females with post-neurosurgical nosocomial bacterial meningitis. It was recorded in the first group that the percentage of post-neurosurgical nosocomial meningitis in all culture-proven adult bacterial meningitis was 12 percent and for the second group it was seen to be 27 percent. The most constant clinical characteristics were fever and gradual consciousness disruption, which may be related to various postoperative neurosurgery issues. The most prevalent pathogens were recorded to be pseudomonas aeruginosa, staphylococcus aureus, coagulase-negative staphylococcus, Acinetobacter baumannii, and lastly, Escherichia coli. During the second era, there was a rise in polymicrobial illnesses and multi antibiotic resistance. Mortality was 22% in the first group of the study and 36% in the second group of the study. Conclusion: The selection of appropriate empirical antibiotics is complex and is necessary to be guided by knowledge of the comparative ratio of multiple diseases as well as the rising prevalence of resistant strains. To increase the likelihood of survival, early diagnosis is suggested with optimal antibiotic selection based on in vitro susceptibility testing, epidemiologic patterns, and lastly, metabolic derangement treatment to be advised and required. Keywords: Bacterial Meningitis, adults, post-neurosurgery

Pharmacokinetic variability of vancomycin in patients with nosocomial meningitis.

High doses of vancomycin are required early in the treatment of nosocomial meningitis. However, the dosage is often reduced later during treatment, irrespective of renal function. This study was designed to investigate the pharmacokinetic variability of vancomycin and the associated factors throughout the treatment course for patients with nosocomial bacterial meningitis. This study included 17 patients who received vancomycin for nosocomial bacterial meningitis at the Tokyo Women's Medical University Yachiyo Medical Center from April 2013 to May 2020. All patients had their serum vancomycin concentrations and cerebrospinal fluid (CSF) parameters measured within 7 days of initiating treatment (early period) and after 8 days (later period) of treatment. The relative error between the predicted serum vancomycin concentration and the measured value was significantly higher in the later period than in the early period. In 13 patients who did not have their dosing interval shortened, the vancomycin dosage/serum vancomycin concentration/estimated glomerular filtration rate (D/C/eGFR) ratio significantly decreased in the later period. Moreover, the rate of change in the D/C/eGFR ratio significantly correlated with that in the CSF protein and C-reactive protein levels. This study suggests that the clinical condition and inflammatory response of a patient with meningitis influence the pharmacokinetics of vancomycin. Therefore, the vancomycin dosage for the treatment of nosocomial bacterial meningitis must be adjusted according to changes in the clinical condition and renal function of the patient, necessitating careful therapeutic drug monitoring.

Characteristics of Post-Neurosurgical Nosocomial Bacterial Meningitis in Adults: A retrospective Cross-Sectional Study

Aim: To analyze the characteristics of Post-neurosurgical nosocomial bacterial meningitis in adults Study design: A retrospective cross-sectional study Place and duration: Riyadh Care Hospital/ National Care Hospital, from July 2005 to June 2010 then 2013 to 2018. Methodology: Over ten years, sixty-two patients above the age of 16 years who suffered from Post-neurosurgical nosocomial bacterial meningitis were evaluated by collecting clinical data. The cases were divided into two categories, the first one from July 2007 to June 2012 and second one from August 2013 to July 2018. Results: Among the 62 patients, there were 43 males and 19 females with post-neurosurgical nosocomial bacterial meningitis. It was recorded in the first group that the percentage of post-neurosurgical nosocomial meningitis in all culture-proven adult bacterial meningitis was 12 percent and for the second group it was seen to be 27 percent. The most constant clinical characteristics were fever and gradual consciousness disruption, which may be related to various postoperative neurosurgery issues. The most prevalent pathogens were recorded to be pseudomonas aeruginosa, staphylococcus aureus, coagulase-negative staphylococcus, Acinetobacter baumannii, and lastly, Escherichia coli. During the second era, there was a rise in polymicrobial illnesses and multi antibiotic resistance. Mortality was 22% in the first group of the study and 36% in the second group of the study. Conclusion: The selection of appropriate empirical antibiotics is complex and is necessary to be guided by knowledge of the comparative ratio of multiple diseases as well as the rising prevalence of resistant strains. To increase the likelihood of survival, early diagnosis is suggested with optimal antibiotic selection based on in vitro susceptibility testing, epidemiologic patterns, and lastly, metabolic derangement treatment to be advised and required. Keywords: Bacterial Meningitis, adults, post-neurosurgery

The course of cerebrospinal fluid parameters ≤ 20 days after aneurysmal subarachnoid hemorrhage

BackgroundAneurysmal subarachnoid hemorrhage (aSAH) patients have an inflammatory response in the cerebrospinal fluid (CSF). We determined CSF cell counts, erythrocyte/leukocyte ratio, and glucose- and protein concentrations in patients ≤20 days after aSAH without bacterial meningitis. Such knowledge may help to interpret CSF parameters in patients with an external drain if nosocomial bacterial meningitis or ventriculitis is suspected. MethodsPatients with aSAH admitted between 2010 and 2017 with at least one CSF sample ≤ 20 days after ictus were included from a prospectively collected database. CSF samples were excluded if the patient used antibiotics or if the CSF culture was positive. We calculated estimated marginal means with 95% confidence intervals (CIs) with linear mixed models for CSF cell counts, glucose- and protein concentrations. ResultsWe included 209 patients with 306 CSF samples. Highest estimated median leukocyte count was 305 (95%CI:225–412) x10^6/L, and the lowest estimated median erythrocyte/leukocyte ratio was 109 (95%CI:73–163). Estimated mean glucose concentrations remained within the normal range. The estimated median protein concentration decreased from 3.3 g/L (95%CI:2.5–4.2) on day 0 to 1.0 g/L (95%CI:0.8–1.2) on day 14. ConclusionThe limits we found for the inflammatory reaction in aSAH patients may help physicians to interpret CSF parameters in aSAH patients with an external CSF drain. Future studies are needed to compare CSF parameters in aSAH patients with and without bacterial meningitis or ventriculitis.

Prevalence and Healthcare Resource Utilization of Community-acquired and Nosocomial Bacterial Meningitis Infections in the United States (S45.004)

Prevalence and Healthcare Resource Utilization of Community-acquired and Nosocomial Bacterial Meningitis Infections in the United States (S45.004)

Méningite nosocomiale postopératoire

Nosocomial bacterial meningitis is a dangerous complication after neurosurgery or meningeal contaminating care. It is a difficult infection to diagnose and to treat. The authors report the case of nosocomial meningitis with a multiresistant Acinetobacter baumannii strain occurring in the post-operative course of a meningioma and which has been follow up during the evolution by empyema to a Citrobacter freundii multi resistant to antibiotics. The diagnosis was based on a range of clinical, biochemical and bacteriological arguments. Evolution was favorable under intrathecal and parenteral treatment.

Community-acquired bacterial meningitis

Meningitis is an inflammation of the meninges and subarachnoid space that can also involve the brain cortex and parenchyma. It can be acquired spontaneously in the community - community-acquired bacterial meningitis - or in the hospital as a complication of invasive procedures or head trauma (nosocomial bacterial meningitis). Despite advances in treatment and vaccinations, community-acquired bacterial meningitis remains one of the most important infectious diseases worldwide. Streptococcus pneumoniae and Neisseria meningitidis are the most common causative bacteria and are associated with high mortality and morbidity; vaccines targeting these organisms, which have designs similar to the successful vaccine that targets Haemophilus influenzae type b meningitis, are now being used in many routine vaccination programmes. Experimental and genetic association studies have increased our knowledge about the pathogenesis of bacterial meningitis. Early antibiotic treatment improves the outcome, but the growing emergence of drug resistance as well as shifts in the distribution of serotypes and groups are fuelling further development of new vaccines and treatment strategies. Corticosteroids were found to be beneficial in high-income countries depending on the bacterial species. Further improvements in the outcome are likely to come from dampening the host inflammatory response and implementing preventive measures, especially the development of new vaccines.

Predictive value of decoy receptor 3 in postoperative nosocomial bacterial meningitis.

Nosocomial bacterial meningitis requires timely treatment, but what is difficult is the prompt and accurate diagnosis of this disease. The aim of this study was to assess the potential role of decoy receptor 3 (DcR3) levels in the differentiation of bacterial meningitis from non-bacterial meningitis. A total of 123 patients were recruited in this study, among them 80 patients being with bacterial meningitis and 43 patients with non-bacterial meningitis. Bacterial meningitis was confirmed by bacterial culture of cerebrospinal fluid (CSF) culture and enzyme-linked immunosorbent assay (ELISA) was used to detect the level of DcR3 in CSF. CSF levels of DcR3 were statistically significant between patients with bacterial meningitis and those with non-bacterial meningitis (p < 0.001). A total of 48.75% of patients with bacterial meningitis received antibiotic >24 h before CSF sampling, which was much higher than that of non-bacterial meningitis. CSF leucocyte count yielded the highest diagnostic value, with an area under the receiver operating characteristic curve (ROC) of 0.928, followed by DcR3. At a critical value of 0.201 ng/mL for DcR3, the sensitivity and specificity were 78.75% and 81.40% respectively. DcR3 in CSF may be a valuable predictor for differentiating patients with bacterial meningitis from those with non-bacterial meningitis. Further studies are needed for the validation of this study.

Epidemiology of bacterial meningitis in the USA from 1997 to 2010: a population-based observational study

Bacterial meningitis continues to be a substantial cause of morbidity and mortality, but the epidemiological trends after adjunctive dexamethasone recommendations are unknown in the USA. We aimed to describe the changing patterns among the most common bacterial causes in the USA after conjugate vaccination and to assess the association between adjunctive dexamethasone and mortality. For this population-based observational study, we searched information available from hospital discharges about incidence and inpatient mortality for the most important causes of community and nosocomial bacterial meningitis based on International Classification of Diseases coding across all hospitals in the USA between 1997 and 2010 with the HealthCare Cost Utilization Project (HCUP) network database. We calculated incidences according to US Census Bureau data and used a negative binomial regression model to evaluate the significance of changes over time. We assessed mortality from pneumococcus for three periods 1997-2001 (baseline), 2002-04 (transition years), and 2005-08 (after corticosteroid recommendations were available). Streptococcus pneumoniae incidence fell from 0·8 per 100 000 people in 1997, to 0·3 per 100 000 people by the end of 2010 (RR 0·3737, 95% CI 0·1825-0·7656). Mortality from pneumococcal meningitis decreased between 2005 (0·049 per 100 000 people) and 2008 (0·024 per 100 000 people) compared with between 2002 (0·073 per 100 000 people) and 2004 (0·063 per 100 000 people; RR 0·5720, 95% CI 0·4303-0·7582). The incidence of Neisseria meningitidis infection decreased from 0·721 per 100 000 people in 1997, to 0·123 per 100 000 people in 2010 (RR 0·1386, 95% CI 0·048-0·4284), which has placed this pathogen close to common bacterial causes of nosocomial meningitis such as staphylococcus and Gram-negative bacteria and to Haemophilus influenzae. S pneumoniae continues to be the leading identifiable cause of bacterial meningitis in the USA, but with a significant decrease in incidence and mortality associated with the introduction of conjugated vaccines and a mortality decrease that is associated with the introduction of recommendations for use of adjunctive dexamethasone for pneumococcal meningitis. National Center for Research Resources.

Changing etiology and risk factors of nosocomial bacterial meningitis: a nationwide multicenter study 1993-2010 in Slovakia

Changing etiology and risk factors of nosocomial bacterial meningitis: a nationwide multicenter study 1993-2010 in Slovakia

Nosocomial Meningitis: Moving beyond Description to Prevention

See Article on Page 171-179 Nosocomial bacterial meningitis may result from invasive procedures (for examples, such as craniotomies, the placement of internal or external ventricular catheters, lumbar puncture, intrathecal infusions of medications, or spinal anesthesia), head trauma, or hospital-acquired bacteremia complicated by metastatic infection [1]. The specific bacteria that cause nosocomial meningitis vary according to the pathogenesis and timing of infection after the predisposing event, so the choice of empirical antimicrobial therapy depends on the pathogenesis of the infection. In particular, the antimicrobial susceptibility profiles for locally common gram negative bacilli must be considered in the approach to empirical therapy [2]. However, there has been no report of nosocomial meningitis in Korea, apart from a number of case series. In this issue of the Korean J Intern Med, Kim et al. [3] described the epidemiology of nosocomial meningitis and its outcomes. They reported that the most common organisms by rank were coagulase-negative staphylococci, Acinetobacter species, and Staphylococcus aureus. Most (78/91, 86%) of the infections were related to the placement of an external ventricular drain (EVD). In the recent literature, the incidence of EVD-related infections ranges from 2% to 27% [4]. In Korea, the reported rate of surgical site infection (SSI) was 3.09-3.68 per 100 operations in nationwide prospective multicenter studies of craniotomy in 2008 and 2009 [5,6]. While the incidence of EVD-related infections and the SSI rates after craniotomy in Kim et al. [3]. were not given, the prevention of EVD-related ventriculomeningitis is of paramount importance because it is a significant cause of morbidity and mortality in critically ill neurological patients. Relevant risk factors have been identified as the duration of catheterization, frequency of EVD manipulation, intraventricular hemorrhage, and insertion techniques [4]. Therefore, the avoidance of modifiable risk factors should be emphasized. Acinetobacter species are nosocomial pathogens of increasing importance, even in post-neurosurgical meningitis, with mortality from this infection exceeding 15% [7]. Alarmingly, Acinetobacter was the second most common cause of nosocomial meningitis in this study. In fact, Acinetobacter can survive in a wide range of environments and persist for extended periods of time on surfaces, which m ake it a frequent cause of outbreaks of infection and an endemic, healthcare-associated pathogen [8]. Acinetobacter is easily transmitted via direct contact with colonized patients or the hands of hospital staff, and even by respiratory droplets. Furthermore, antimicrobial therapy for these pathogens has become problematic, as they are frequently resistant to expanded-spectrum cephalosporins and carbapenems. Given the emergence of carbapenem-resistant Acinetobacter species, the therapeutic options are limited and no optimal treatment has been established [9]. Consistent with these findings, Kim et al. [3] reported that 26% of Acinetobacter species were resistant to imipenem and 27% of the patients infected with them died. Therefore, infection-control measures should be enforced vigorously to prevent person-to-person spread and cross-infection from the environment. In conclusion, nosocomial bacterial meningitis poses a substantial challenge because of the emergence of disease caused by multidrug resistant organisms (MDROs) and severely limited treatment options. Encouraged by recent progress in reducing the incidence of infections associated with invasive devices, we should now turn our attention to preventing and controlling infection due to MDROs. The time is right to make effective prevention the new status quo.

Nosocomial Bacterial Meningitis

Nosocomial bacterial meningitis is most often related to either complicated head trauma or invasive procedures, such as craniotomy, placement of ventricular catheters, intrathecal infusion of medications, or spinal anesthesia. In addition, metastatic infection from hospital-acquired bacteremia occasionally leads to meningitis. The conditions are associated with different pathogenetic mechanisms and a different spectrum of microorganisms, and therefore the choice of empirical antimicrobial therapy will vary according to the condition.

Management of Nosocomial Bacterial Meningitis

This review article by van de Beek and colleagues discusses the risk factors for nosocomial meningitis and its prevention, identification, and

Nosocomial Bacterial Meningitis

Nosocomial bacterial meningitis is most often related to either complicated head trauma or invasive procedures, such as craniotomy, placement of ventricular catheters, intrathecal infusion of medications, or spinal anesthesia. In addition, metastatic infection from hospital-acquired bacteremia occasionally leads to meningitis. The conditions are associated with different pathogenetic mechanisms and a different spectrum of microorganisms, and therefore the choice of empirical antimicrobial therapy will vary according to the condition.

Nosocomial bacterial meningitis in adults: a prospective series of 50 cases

In order to evaluate characteristics of nosocomial meningitis in adults, we performed a prospective cohort study of 50 episodes of nosocomial bacterial meningitis. These cases were confirmed by culture of cerebrospinal fluid (CSF) in patients aged >16 years. Classic symptoms of bacterial meningitis (headache, neck stiffness and fever) were present in >70% of the episodes, although only a minority (41%) presented with impairment of consciousness. Underlying conditions, such as a history of neurosurgery, recent head injury, CSF leakage or a distant focus of infection, were present in 94% of the episodes. Staphylococcus aureus was the most common pathogen in patients with a history of neurosurgery, causing 10 of 32 episodes (31%). Patients with a distant focus of infection, such as otitis, sinusitis or pneumonia were more likely to have meningitis due to Streptococcus pneumoniae than patients without [six of nine episodes (67%) vs seven of 41 (17%); P=0.01]. Complications occurred in 50% of the episodes and 16% of the patients died. Our study confirms that adults with nosocomial meningitis are a distinct patient group with specific bacterial pathogens, as compared to those with community-acquired bacterial meningitis. Underlying conditions, especially a history of neurosurgery or a distant focus of infection, were present in the large majority of patients, and mortality and morbidity rates were high.

Distinguishing bacterial from viral meningitis: the critical importance of the CSF lactic acid: author's reply

Sir: We thank Dr. Cunha for his attention to our multivariate approach of community-acquired bacterial meningitis [1]. He suggests that combining clinical presentation with the clinical severity is helpful in distinguishing bacterial from viral meningitis according to the study by Durand et al. [2], that meningoencephalitis is rare during bacterial meningitis (BM), that CSF lactate values are of interest for the diagnosis, and thus that there was no need to use a multivariate approach. In contrast with Durand et al. who analyzed only community-acquired and nosocomial BM, we compared the clinical presentation and the CSF findings in confirmed, acute community-acquired BM with those observed during viral meningitis. Whereas most of BM series have included nearly 20% unconfirmed BM [2, 3], we paid special attention to enroll only microbiologically documented BM. Therefore we believe that the clinical findings of our population are representative of the clinical presentation of BM. In the past it was thought that BM is only a meningitis, and thus many physicians believe that its diagnosis depends only on the CSF findings. In fact, signs of cerebral dysfunction such as declining consciousness, seizures, and focal neurological deficits are found in 85% of patients presenting with acute BM [4]. Furthermore, in accordance with our results, Behrman et al. [5] demonstrated that all patients with BM have a change in mental status, while none of the aseptic meningitis patients do. We agree with the fact that definitive diagnosis of meningitis depends on CSF analysis, but one of the two predictors of BM in our model was an absolute neutrophil count of PMN greater than 1,000/mm3 and not the absolute CSF white blood cell. Dr. Cunha highlights that CSF glucose was not a predictor of BM in our series. This finding is explained mainly by the important weight of the clinical presentation and conforms with the results of the three studies that have used a multivariate approach to evaluate the performance of initial clinical presentation to distinguish between bacterial and viral meningitis. However, when using only CSF findings, CSF glucose level was a predictor of BM (results not shown). CSF lactate level could have been of interest, but according to the retrospective design of our study, this marker was not determined. Furthermore, its predictive value have never been evaluated in a multivariate model, but according to the weight of the clinical presentation, this parameter may be not predictive. In any case, our main purpose was to highlight the fact that a patient with a high suspicion of meningitis without any sign of severity, i.e., abnormal neurological findings and/or shock at admission is at very low probability of BM, even if the CSF percentage of PMN is high, a common presenting emergency department problem evaluated in the United States at 1 case per 1,000 visits per year [6]. Our model may be useful to reduce unnecessary hospitalization, duration of antibiotics (if used) and imaging. In contrast, all patients with meningoencephalitis must be immediately evaluated and must receive antibiotics or acyclovir according to the CSF findings without delay.

Post-neurosurgical nosocomial bacterial meningitis in adults: microbiology, clinical features, and outcomes

The clinical data of 62 adult patients who suffered post-neurosurgical nosocomial bacterial meningitis, retrospectively collected over a 16-year period, were studied. Cases were divided into two groups based on the date of presentation, the first period being 1986-1993 and the second 1994-2001. Fever and progressive consciousness disturbance were the most consistent clinical features - signs that may also be attributed to other postoperative neurosurgical problems. The common pathogens included Staphylococcus aureus, coagulase negative Staphylococcus, Pseudomonas aeruginosa, Escherichia coli, and Acinetobacter baumannii. An increase in polymicrobial infections and multi-antibiotic resistance during the second period was identified. In the first half of the study, mortality was 22%, and in the second half 36%. Adult post-neurosurgical nosocomial bacterial meningitis has become an important clinical problem. The choice of appropriate empirical antibiotics is challenging and must be guided by an awareness of the relative frequency of various pathogens and the increasing incidence of resistant strains. Although high mortality rates may, in part, be related to the primary brain pathology, early diagnosis and the timely use of antibiotics based on antimicrobial susceptibility testing are essential for survival.