title: Clinical characteristics of Stenotrophomonas maltophilia meningitis in adults: a high incidence in patients with a postneurosurgical state, long hospital staying and antibiotic use.
abstract: OBJECTIVE
  Stenotrophomonas (S.) maltophilia is an uncommon pathogen of adult bacterial meningitis (ABM).
  
  
  METHODS
  The clinical characteristics of six S. maltophilia ABM cases, collected during a study period of nine years (2001-2009) were included. In the related literature, 13 S. maltophilia ABM cases were reported, and their clinical data were also collected.
  
  
  RESULTS
  The 19 S. maltophilia ABM cases included 11 men and 8 women, aged 28-70 years. Of these 19 cases, 89.5% (17/19) had underlying neurosurgical (NS) conditions as the preceding event. Before the development of S. maltophilia ABM, 52.6% (10/19) of them had long stays in hospital and 63.2% (12/19) had undergone antibiotic treatment. Among the implicated S. maltophilia cases, three strains were found to have a resistance to sulfamethoxazole-trimethoprim (SMZ-TMP). Two of our five cases had resistant strains to levofloxacin. Among the antibiotics chosen for treatment, SMZ-TMP was the most common followed by quinolone (ciprofloxacin, levofloxacin, moxifloxacin). The therapeutic results showed 2 cases expired while the other 17 cases survived.
  
  
  CONCLUSIONS
  S. maltophilia ABM usually develops in patients with a preceding neurosurgical condition, a long hospital stay and antibiotic use. SMZ-TMP and quinolones, especially the ciprofloxacin, are the major antibiotic used. This study also shows the emergence of clinical S. maltophilia strains which are not susceptible to SMZ-TMP and quinolones and this development may pose a more serious threat in the near future because treatment options may become depleted and limited despite the mortality rate of this specific group of ABM not being high at this time.
authors.affiliation: Department of Neurology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Chi-Ren
authors.initials: CR
authors.lastname: Huang
authors.forename: Shu-Feng
authors.initials: SF
authors.lastname: Chen
authors.forename: Nai-Wen
authors.initials: NW
authors.lastname: Tsai
authors.forename: Chiung-Chih
authors.initials: CC
authors.lastname: Chang
authors.forename: Chen-Hsien
authors.initials: CH
authors.lastname: Lu
authors.forename: Yao-Chung
authors.initials: YC
authors.lastname: Chuang
authors.forename: Chun-Chih
authors.initials: CC
authors.lastname: Chien
authors.forename: Wen-Neng
authors.initials: WN
authors.lastname: Chang
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D002494:Central Nervous System Infections / Q000453:epidemiology; D024881:Drug Resistance, Bacterial; D005260:Female; D024841:Fluoroquinolones / Q000494:pharmacology / Q000627:therapeutic use; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy* / Q000209:etiology* / Q000382:microbiology; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008297:Male; D016920:Meningitis, Bacterial / Q000188:drug therapy* / Q000209:etiology* / Q000382:microbiology; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D011183:Postoperative Complications / Q000188:drug therapy* / Q000453:epidemiology; D012189:Retrospective Studies; D020615:Stenotrophomonas maltophilia / Q000187:drug effects; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000494:pharmacology / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones; D015662:Trimethoprim, Sulfamethoxazole Drug Combination
keywords: Meningitis; Post-neurosurgical; Stenotrophomonas maltophilia