Post-surgical enterococcal meningitis: clinical and epidemiological study of 20 cases.
Enterococcal post-surgical meningitis is an uncommon disease. 20 episodes of nosocomial post-surgical enterococcal meningitis diagnosed between 1994 and 2003 were retrospectively studied. During the period of study 20 cases of post-surgical enterococcal meningitis (60% female, mean age 55+/-18 y, range 16-78 y) were reviewed. The mean time between admission at the hospital and surgery was 26 (SD = 15) d (range 7-61 d). The most frequent underlying diseases were: intracerebral haemorrhage (55%), brain neoplasms (25%), head trauma (15%) and hydrocephalus (5%). 11 patients had previously received antibiotic treatment. The isolates identified were Enterococcus faecalis (n = 18) (90%), E. faecium (1) and E. durans (1). 11 patients had polymicrobial infections. The treatment most frequently used was vancomycin alone or with other antibiotics (11). In 5 patients intrathecal vancomycin (20 mg/d) was also added. The mortality rate was not different in intrathecally treated patients. Cerebrospinal fluid (CSF) devices were removed in 8 patients. Four patients died due to the infection. Mortality was significantly associated with lack of removal of the CSF devices (p = 0.04). Enterococcal spp. are a cause of nosocomial meningitis associated with neurosurgical procedures and the presence of neurological devices.
Guardado
Rodríguez
R
Infectious Diseases, Hospital Central de Asturias, Oviedo, Spain. cuca22@inicia.es
Asensi
V
V
Torres
J M
JM
Pérez
F
F
Blanco
A
A
Maradona
J A
JA
Cartón
J A
JA
D000293:Adolescent; D000328:Adult; D000368:Aged; D003428:Cross Infection / Q000134:cerebrospinal fluid / Q000453:epidemiology* / Q000382:microbiology*; D016983:Enterococcus / Q000254:growth & development / Q000302:isolation & purification*; D005260:Female; D006801:Humans; D008297:Male; D016920:Meningitis, Bacterial / Q000134:cerebrospinal fluid / Q000453:epidemiology* / Q000382:microbiology; D008875:Middle Aged; D011183:Postoperative Complications / Q000134:cerebrospinal fluid / Q000453:epidemiology* / Q000382:microbiology*; D012189:Retrospective Studies