Post-neurosurgical Bacterial Meningitis Research Articles

Mixed infection in adult post-neurosurgical bacterial meningitis: A hospital-based study

Post-neurosurgical (post-NS) adult bacterial meningitis (ABM) with mixed infection is rarely examined solely in the literature. The clinical features and laboratory data of post-NS ABM patients with mixed infection were included for analysis. Totally 170 post-NS ABM cases were identified and 18 (11 men and 7 women, aged 20-77 years, median = 57.5) of them had a mixed infection. A total of 45 bacterial strains including 34 Gram-negative [Gm(-)] strains and 11 Gram-positive [Gm(+)] strains were isolated. Of the implicated pathogens, Escherichia coli, Acinetobacter, Pseudomonas, and Klebsiella spp. were the common Gm(-) strains, while staphylococcal, streptococcal, and enterococcal strains were the common Gm(+) strains. Compared with the post-NS ABM cases with monomicrobial infection, those with mixed infection had a lower cerebrospinal fluid (CSF) white blood cell count. The mortality rate of post-NS ABM cases was 33.3% (6/18) without significant clinical and laboratory difference between the fatal and non-fatal groups. Mixed infection is not uncommon in post-NS ABM (10.6%, 18/170), and its mortality rate is high. Seventy-six percent of the implicated bacterial pathogens belonged to Gm(-) strains, while the other 24% were Gm(+) strains. The clinical and laboratory features of ABM with mixed infection are not unique; its diagnosis can only be confirmed by a positive CSF culture.

Caulobacter Species as a Cause of Postneurosurgical Bacterial Meningitis in a Pediatric Patient

Caulobacter species have been rarely found to be a cause of human infection. A case of probable Caulobacter species meningitis occurring postneurosurgery in a pediatric patient is reported in the present article. Gram stain and colony morphology of the isolate were not consistent with the identification provided by commercial phenotypic identification systems. The present case illustrates the need to reconcile conflicting phenotypic test results using 16S ribosomal DNA sequencing.

Pharmacokinetics and protein binding of linezolid in cerebrospinal fluid and serum in a case of post-neurosurgical bacterial meningitis

We describe a case of bacterial meningitis in a patient administered linezolid (LZD). The ratio of free to total LZD concentrations in cerebrospinal fluid (CSF) was 1 for all measurements, and the LZD concentration in CSF measured at the trough level was almost the same as the free serum concentration.

Influence of Third-generation Cephalosporin Resistance on Adult In-hospital Mortality From Post-neurosurgical Bacterial Meningitis

To investigate the clinical features, etiology and predictors of in-hospital mortality in adults with post-neurosurgical bacterial meningitis. This retrospective analysis included 60 adult patients with culture-proven post-neurosurgical bacterial meningitis hospitalized between September 2006 and August 2008. Of the 60 patients, 88.3% had monomicrobial infection and 11.7% had mixed infection. The mean duration from the first neurosurgical procedure to the diagnosis of meningitis was 21 days (range, 1-134 days). The median frequency of neurosurgical procedure before meningitis was 1 (range, 1-5). A total of 69 isolates were identified from the cerebrospinal fluid, the most common pathogens were Gram-negative bacilli (43, 62.3%), followed by Gram-positive bacteria (24, 34.8%). The three most common Gram-negative bacilli were Serratia marcescens (7, 10.1%), Klebsiella pneumoniae (6, 8.7%), and Enterobacter cloacae (4, 5.8%). Pseudomonas aeruginosa and Acinetobacter baumannii isolates comprised less than 3%. Notably, glucose non-fermenting Gram-negative bacilli other than Acinetobacter and Pseudomonas spp. accounted for 11.6% of the total. Of the Gram-negative bacilli, resistance rates to the third-generation cephalosporins, ceftriaxone and ceftazidime, were 58.1% and 34.9%, respectively. The two most common Gram-positive pathogens were Staphylococcus aureus (10, 14.5%) and coagulase-negative staphylococci (including S. epidermidis) (10, 14.5%). The in-hospital mortality rate was 15.0%, which was significantly related to Gram-negative bacilli resistant to third-generation cephalosporins in multivariate analysis (adjusted odds ratio = 33.65; p = 0.047). These findings may portend the spread of serious resistance to third-generation cephalosporins in nosocomial Gram-negative bacilli throughout the neurosurgical units, suggestive of the need to reassess the empirical use of third-generation cephalosporins in post-neurosurgical bacterial meningitis.

Risk factors and prognostic indicators of bacterial meningitis in a cohort of 3580 postneurosurgical patients.

In order to identify the incidence, risk factors and prognostic indicators of postneurosurgical bacterial meningitis, a 9-y retrospective cohort study was performed. The cohort comprised 3580 individuals who underwent neurosurgical operations at the Department of Neurosurgery of Catholic University, Rome, a 1,700-bed university hospital. We observed 52 episodes of postneurosurgical meningitis, with infection rates of 1.4/100 patients, 0.8/100 operations for craniotomies and 2.6/100 operations for internal cerebrospinal fluid (CSF) shunt or ventriculostomy with external drainage. The overall infection rate decreased from 2.5/100 operations in 1989 to 0.9/100 in 1997 (p = 0.03). Logistic regression analysis indicated that duration of ventriculostomy with external drainage [p < 0.01; odds ratio (OR) = 9.67; 95% confidence interval (CI) = 2.44-38.321 and increasing value of the APACHE III score (p <0.01; OR = 8.51; 95% CI = 2.15-33.68) were independent risk factors for development of meningitis. The overall case fatality rate was 8%. Predictors of mortality were low ( < 1.66 mmol/l) CSF glucose concentration (p = 0.001), increasing value of the APACHE IIl score (p = 0.002) and Gram-negative aetiology (p = 0.003).