Gram-negative bacillary meningitis in adult post-neurosurgical patients.
BACKGROUND
To assess the clinical features and therapeutic outcomes of gram-negative bacillary meningitis (GNBM) in adult postneurosurgical patients.


METHODS
Thirty adult patients with GNBM were included in this study. Their clinical features, laboratory data, prognostic factors, and therapeutic outcome were analyzed. The patients were 22 males and 8 females, aged 17-72 years. Seven had community-acquired infections and 23 had nosocomial infections. Two patients were associated with brain abscess.


RESULTS
The pathogens found in the 30 GNBM patients were Pseudomonas aeruginosa, Klebsiella species, Escherichia coli, Acinetobacter baumannii, and some rare pathogens including Citrobacter freundii, Serratia marcescens, Enterobacter cloacae, and Proteus mirabilis. Among these 30 patients, 8 patients with third-generation cephalosporin-resistant GNBM were identified since 1994; all infections were nosocomially acquired. Appropriate antibiotics were given to 22 patients. Eight patients did not receive appropriate antibiotic therapy. All eight died. The mortality rate in those treated with appropriate antibiotics was 14%.


CONCLUSIONS
There has been an increase of GNBM in postneurosurgical patients in recent years. In addition, the emergence of strains resistant to third-generation cephalosporins in this specific group of patients has also been noted in recent years, and has become a great therapeutic challenge. We noted many prognostic factors in postneurosurgical patients in this study; however, appropriate antibiotic therapy and initial consciousness level are the most significant ones. Therefore, in cases of postneurosurgical patients with nosocomially acquired GNBM, the possibility of third-generation cephalosporin resistance should be strongly suspected. Early initiation of appropriate antibiotic therapy is needed in this potentially fatal disease.
Lu
C H
CH
Department of Neurology, Chang Gung Memorial Hospital-Kaohsiung, Hsien, Taiwan.
Chang
W N
WN
Chuang
Y C
YC
Chang
H W
HW
D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002490:Central Nervous System / Q000601:surgery; D018550:Cephalosporin Resistance; D003428:Cross Infection / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality; D005260:Female; D006090:Gram-Negative Bacteria / Q000145:classification / Q000302:isolation & purification / Q000502:physiology; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology / Q000401:mortality; D006801:Humans; D008297:Male; D016920:Meningitis, Bacterial / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology / Q000401:mortality; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents