Significance of nucleic acid testing in diagnosis and treatment of post-neurosurgical meningitis caused by multidrug-resistant Acinetobacter baumannii: a case report.
BACKGROUND
Neurosurgery may pose the risk of patients' developing nosocomial meningitis caused by infection with hospital pathogens. Rapid detection of the causative pathogens is essential for selecting the appropriate antibiotic treatment. However, the classical culture-based detection of bacterial infection is time-consuming and often fails to establish the correct diagnosis. Molecular techniques offer improved diagnostic means to guide the proper antibiotic therapy.


METHODS
A 32-year-old Vietnamese man underwent neurosurgery and subsequently developed meningitis. The classical bacterial culture method failed to detect any infectious agents, whereas polymerase chain reaction-based assays identified Acinetobacter baumannii as the causative pathogen. In addition, detection of the acquired extended-spectrum beta-lactamase gene VEB and carbapenem resistance genes NDM-1 and IMP suggested that the isolated A. baumannii strain was multidrug resistant. Upon the establishment of the correct diagnosis, an adequate treatment regimen was chosen and he recovered completely.


CONCLUSIONS
This case report demonstrates the usefulness of the molecular approach as an important addendum and alternative to culture-based diagnosis in order to detect the pathogen causative for meningitis, including the indicators for resistance.
Department of Molecular Biology, 108 Military Central Hospital, Hanoi, Vietnam.|Vietnamese-German Centre for Medical Research, 108 Military Hospital, Hanoi, Vietnam.
Ngo Tat
NT
Trung
Institute of Clinical Infectious Diseases, 108 Military Central Hospital, No 1, Tran Hung Dao Street, Hai Ba Trung Dist, Hanoi, Vietnam.
Trinh
T
Van Son
Department of Molecular Biology, 108 Military Central Hospital, Hanoi, Vietnam.
Dao Thanh
DT
Quyen
Department of Molecular Biology, 108 Military Central Hospital, Hanoi, Vietnam.
Dang Thi Viet
DT
Anh
Institute of Clinical Infectious Diseases, 108 Military Central Hospital, No 1, Tran Hung Dao Street, Hai Ba Trung Dist, Hanoi, Vietnam.
Vu Viet
VV
Sang
Institute of Clinical Infectious Diseases, 108 Military Central Hospital, No 1, Tran Hung Dao Street, Hai Ba Trung Dist, Hanoi, Vietnam.
Nguyen Xuan
NX
Lam
Institute of Clinical Infectious Diseases, 108 Military Central Hospital, No 1, Tran Hung Dao Street, Hai Ba Trung Dist, Hanoi, Vietnam.
Nguyen Dang
ND
Manh
Institute of Clinical Infectious Diseases, 108 Military Central Hospital, No 1, Tran Hung Dao Street, Hai Ba Trung Dist, Hanoi, Vietnam.
Vuong Phuc
VP
Duong
Institute of Clinical Infectious Diseases, 108 Military Central Hospital, No 1, Tran Hung Dao Street, Hai Ba Trung Dist, Hanoi, Vietnam.
Bui Tri
BT
Cuong
Institute of Clinical Infectious Diseases, 108 Military Central Hospital, No 1, Tran Hung Dao Street, Hai Ba Trung Dist, Hanoi, Vietnam.
Quyen Dang
QD
Tuyen
Institute of Clinical Infectious Diseases, 108 Military Central Hospital, No 1, Tran Hung Dao Street, Hai Ba Trung Dist, Hanoi, Vietnam.
Nguyen Xuan
NX
Chinh
Department of Molecular Biology, 108 Military Central Hospital, Hanoi, Vietnam.
Phan Quoc
PQ
Hoan
Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany.|Vietnamese-German Centre for Medical Research, 108 Military Hospital, Hanoi, Vietnam.
Hoang
H
Van Tong
Vietnamese-German Centre for Medical Research, 108 Military Hospital, Hanoi, Vietnam.
Christian G
CG
Meyer
Department of Molecular Biology, 108 Military Central Hospital, Hanoi, Vietnam. lehuusong@108-icid.com.|Institute of Clinical Infectious Diseases, 108 Military Central Hospital, No 1, Tran Hung Dao Street, Hai Ba Trung Dist, Hanoi, Vietnam. lehuusong@108-icid.com.|Vietnamese-German Centre for Medical Research, 108 Military Hospital, Hanoi, Vietnam. lehuusong@108-icid.com.
Le Huu
LH
Song
D000151:Acinetobacter Infections / Q000175:diagnosis* / Q000188:drug therapy; D040981:Acinetobacter baumannii / Q000302:isolation & purification*; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003428:Cross Infection / Q000175:diagnosis / Q000188:drug therapy; D024901:Drug Resistance, Multiple, Bacterial; D006801:Humans; D008297:Male; D008581:Meningitis / Q000175:diagnosis* / Q000188:drug therapy; D009493:Neurosurgery; D016133:Polymerase Chain Reaction / Q000379:methods*; D011183:Postoperative Complications / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology
D000900:Anti-Bacterial Agents
Acinetobacter baumannii; Bacterial culture; Hospital infection; Meningitis; Neurosurgery; Nucleic acid testing