title: Resistance to third-generation cephalosporins in adult gram-negative bacillary meningitis.
abstract: Ninety-three patients with gram-negative bacillary meningitis (GNBM) were identified at Kaohsiung Chang Gung Memorial Hospital, over a period of 12 years. Among them, eight showed resistance to third-generation cephalosporins, accounting for 9% of the total GNBM cases and 29% of the postneurosurgical GNBM cases. The resistant pathogens included Acinetobacter baumannii, Klebsiella pneumoniae, Citrobacter freundii and Morganella morganii. These eight patients, six males and two females aged 18-61 years, all had nosocomially acquired meningitis associated with head trauma and/or postneurosurgical states. Six patients received imipenem/cilastatin treatment; five survived and one died. The other two expired because they did not receive appropriate antibiotic treatment. Although third-generation cephalosporin-resistant GNBM is rare, its incidence has been increasing over the past 5 years. In patients with nosocomially-acquired postneurosurgical GNBM, the presence of third-generation cephalosporin resistance should therefore be highly suspected. The appropriate choice of antibiotic is essential for their survival.
authors.affiliation: Dept. of Neurology, Chang Gung Memorial Hospital, Kaohsiung Hsien, Taiwan.
authors.forename: C H
authors.initials: CH
authors.lastname: Lu
authors.forename: W N
authors.initials: WN
authors.lastname: Chang
authors.forename: Y C
authors.initials: YC
authors.lastname: Chuang
mesh_terms: D000293:Adolescent; D000328:Adult; D002511:Cephalosporins / Q000627:therapeutic use*; D004352:Drug Resistance, Microbial; D005260:Female; D006090:Gram-Negative Bacteria / Q000187:drug effects*; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy / Q000382:microbiology*; D006801:Humans; D008297:Male; D016920:Meningitis, Bacterial / Q000188:drug therapy / Q000382:microbiology*; D008875:Middle Aged
chemical_list: D002511:Cephalosporins