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.
Wang
Kuo-Wei
KW
Department of Neurosurgery, Chang Gung Memorial Hospital-Kaohsiung, Kaohsiung, Taiwan.
Chang
Wen-Neng
WN
Huang
Chi-Ren
CR
Tsai
Nai-Wen
NW
Tsui
Huan-Wen
HW
Wang
Hung-Chen
HC
Su
Thung-Ming
TM
Rau
Cheng-Shyuan
CS
Cheng
Ben-Chung
BC
Chang
Chen-Sheng
CS
Chuang
Yao-Chung
YC
Liliang
Po-Chou
PC
Tsai
Yu-Duan
YD
Lu
Cheng-Hsien
CH
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001419:Bacteria / Q000302:isolation & purification / Q000472:pathogenicity; D005260:Female; D005334:Fever / Q000382:microbiology / Q000503:physiopathology; D006801:Humans; D008297:Male; D016920:Meningitis, Bacterial / Q000209:etiology* / Q000382:microbiology* / Q000401:mortality / Q000628:therapy*; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents