Gram-negative bacillary meningitis after cranial surgery or trauma in adults.
In order to assess the clinical features, aetiology, treatment and outcome of post-neurosurgical and post-traumatic Gram-negative bacillary meningitis (GNBM) we performed a retrospective review of all adult patients admitted to the Department of Neurosurgery who had Gram-negative bacilli cultured from cerebrospinal fluid (CSF) following a neurosurgical procedure or traumatic head/spinal injury. During the 12 y of the review 33 patients had CSF isolates of Gram-negative bacilli that were thought to be significant. The median patient age was 47 y (range 22-77 y) and 21 (64%) were male. Klebsiella pneumoniae, Enterobacter cloacae and Escherichia coli were the most common isolates. Minimal inhibitory concentrations (MIC) measured for half the patients' isolates resulted in 5 regimen changes, including 2 patients with E. cloacae meningitis in whom cephalosporin susceptibility decreased during cephalosporin treatment. Our recommended initial treatment was intravenous ceftriaxone and amikacin, subsequently tailored by susceptibility results; approximately half the patients remained on the antibiotics they started and half were changed to an alternate regimen, most often a carbapenem. Five patients (15%) died, 1 dying after cure of his GNBM. There were no failures in those who received more than 12 d of appropriate treatment: treatment for at least 14 d after the last positive CSF culture guaranteed cure. Initial ceftriaxone and amikacin subsequently changing to susceptibility driven alternatives, often a carbapenem, resulted in cure of 85% of our patients with GNBM.
Briggs
Simon
S
Department of Infectious Diseases, Auckland Hospital, Auckland, New Zealand.
Ellis-Pegler
Rod
R
Raymond
Nigel
N
Thomas
Mark
M
Wilkinson
Lucille
L
D000328:Adult; D017677:Age Distribution; D000368:Aged; D000900:Anti-Bacterial Agents; D001930:Brain Injuries / Q000150:complications; D004359:Drug Therapy, Combination / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006090:Gram-Negative Bacteria / Q000187:drug effects / Q000302:isolation & purification*; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D015994:Incidence; D007262:Infusions, Intravenous; D008297:Male; D016920:Meningitis, Bacterial / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology*; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects; D009520:New Zealand / Q000453:epidemiology; D012189:Retrospective Studies; D012720:Severity of Illness Index; D017678:Sex Distribution; D016019:Survival Analysis; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents