The causes and treatment outcomes of 91 patients with adult nosocomial meningitis.
OBJECTIVE
Frequent pathogens of nosocomial meningitis were investigated and the adequacy of empiric antibiotic therapy was assessed. Outcomes of nosocomial meningitis were also evaluated.


METHODS
Ninety-one patients, who were diagnosed and treated for nosocomial meningitis at a single tertiary hospital in Daegu, Korea for 10 years, were included. Medical record and electronic laboratory data on the causative pathogens, antibiotics used, and outcomes were retrospectively investigated.


RESULTS
Coagulase-negative Staphylococcus (40.9%) was the most common pathogen, followed by Acinetobacter (32.5%). Both were cultured as a single organism in cerebrospinal fluid (CSF). Seventy-eight patients (85.7%) had infections related to external ventricular drains (EVD). The most common empirical antibiotics were extended-spectrum beta-lactam antibiotics plus vancomycin (35/91, 38.6%). Of the 27 patients who had cultured Acinetobacter in CSF, 10 (37%) were given the wrong empirical antibiotic treatment. Seven of the 27 patients (26.9%) with cultured Acinetobacter died, and overall mortality of the 91 patients was 16.5%. In the multivariate analysis, the presence of combined septic shock (p < 0.001) and a persistent EVD state (p = 0.021) were associated with a poor prognosis.


CONCLUSIONS
Acinetobacter is one of the leading pathogens of nosocomial meningitis and may lead to inadequate coverage of empiric antibiotic therapy due to increasing resistance. An EVD should be removed early in cases of suspected nosocomial meningitis, and carbapenem might be required for the poor treatment response.
Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea.
Hye-In
HI
Kim
Shin-Woo
SW
Kim
Ga-Young
GY
Park
Eu-Gene
EG
Kwon
Hyo-Hoon
HH
Kim
Ju-Young
JY
Jeong
Hyun-Ha
HH
Chang
Jong-Myung
JM
Lee
Neung-Su
NS
Kim
D000150:Acinetobacter / Q000145:classification / Q000302:isolation & purification*; D000151:Acinetobacter Infections / Q000134:cerebrospinal fluid / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002555:Cerebrospinal Fluid / Q000382:microbiology; D003428:Cross Infection / Q000134:cerebrospinal fluid / Q000175:diagnosis / Q000382:microbiology* / Q000401:mortality / Q000628:therapy*; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D016920:Meningitis, Bacterial / Q000134:cerebrospinal fluid / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology* / Q000401:mortality; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D056910:Republic of Korea; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000134:cerebrospinal fluid / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology* / Q000401:mortality; D013210:Staphylococcus / Q000145:classification / Q000302:isolation & purification*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
D000900:Anti-Bacterial Agents