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Albin CSW, Cunha CB, Glaser TP, Schachter M, Snow JW, Oto B. The Approach to Altered Mental Status in the Intensive Care Unit. Semin Neurol 2024. [PMID: 39137901 DOI: 10.1055/s-0044-1788894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2024]
Abstract
Altered mental status (AMS) is a syndrome posing substantial burden to patients in the intensive care unit (ICU) in both prevalence and intensity. Unfortunately, ICU patients are often diagnosed merely with syndromic labels, particularly the duo of toxic-metabolic encephalopathy (TME) and delirium. Before applying a nonspecific diagnostic label, every patient with AMS should be evaluated for specific, treatable diseases affecting the central nervous system. This review offers a structured approach to increase the probability of identifying specific causal etiologies of AMS in the critically ill. We provide tips for bedside assessment in the challenging ICU environment and review the role and yield of common neurodiagnostic procedures, including specialized bedside modalities of diagnostic utility in unstable patients. We briefly review two common etiologies of TME (uremic and septic encephalopathies), and then review a selection of high-yield toxicologic, neurologic, and infectious causes of AMS in the ICU, with an emphasis on those that require deliberate consideration as they elude routine screening. The final section lays out an approach to the various etiologies of AMS in the critically ill.
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Affiliation(s)
| | - Cheston B Cunha
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
- Rhode Island Hospital, Providence, Rhode Island
| | - Timlin P Glaser
- University of Arizona College of Medicine, Phoenix, Arizona
- Banner University Medical Center, Phoenix, Arizona
| | | | - Jerry W Snow
- University of Arizona College of Medicine, Phoenix, Arizona
- Banner University Medical Center, Phoenix, Arizona
| | - Brandon Oto
- sBridgeport Hospital, Yale New Haven Health, Bridgeport, Connecticut
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2
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Cheyne I, Hassan K, Dunkel T, Sota M, Wróblewski Ł, Mikaszewska-Sokolewicz M. Effective Treatment of Acinetobacter baumannii Ventriculitis With Interventricular Colistin: A Case Report. Cureus 2024; 16:e62169. [PMID: 38993404 PMCID: PMC11238891 DOI: 10.7759/cureus.62169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2024] [Indexed: 07/13/2024] Open
Abstract
Cerebrospinal fluid shunts are the primary treatment for hydrocephalus. However, prolonged external ventricular drain (EVD) use can lead to central nervous system (CNS) infections such as ventriculitis. In the ICU setting, nosocomial infections with gram-negative, multi-drug resistant (MDR) organisms such as Acinetobacter baumannii (AB) prevail, leading to poor outcomes. AB infections are notably challenging due to their genetic drug resistance. Colistin has been reintroduced for use against gram-negative MDR pathogens but has limitations in CNS penetration when administered intravenously. Therefore, intraventricular (IVT) or intrathecal administration of colistin is recommended to enhance its therapeutic reach within the CNS. We present a case of a 22-year-old male admitted after an electric scooter accident with head trauma and hydrocephalus. A ventriculoperitoneal (VP) shunt was inserted, complicated by a nosocomial neuroinfection. Empiric IV therapy with meropenem and vancomycin was initiated. The VP shunt culture identified AB susceptible only to colistin. Intravenous (IV) colistin was added to meropenem with no significant improvement. The addition of IVT colistin significantly improved the patient's neurological condition and reduced inflammatory markers. The patient experienced one myoclonic seizure during IVT colistin treatment, managed with antiepileptics. After multiple unrelated nosocomial complications, the patient was discharged in good condition to rehabilitation. This case suggests that IVT colistin, combined with IV administration, may be preferable over IV colistin alone. Medical staff should be informed about the correct prevention and care of EVD-associated infections.
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Affiliation(s)
- Ithamar Cheyne
- Anesthesiology and Intensive Care Scientific Circle English Division (ANKONA ED), Medical University of Warsaw, Warsaw, POL
| | - Kamelia Hassan
- Anesthesiology and Intensive Care Scientific Circle English Division (ANKONA ED), Medical University of Warsaw, Warsaw, POL
| | - Tjard Dunkel
- Anesthesiology and Intensive Care Scientific Circle English Division (ANKONA ED), Medical University of Warsaw, Warsaw, POL
| | - Marcin Sota
- Anesthesiology and Intensive Care Scientific Circle English Division (ANKONA ED), Medical University of Warsaw, Warsaw, POL
| | - Łukasz Wróblewski
- 2nd Department of Anesthesiology and Intensive Care, Medical University of Warsaw, Warsaw, POL
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3
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Xu J, Du X, Li D, Li P, Guo Q, Xu X, Hu F, Wang M. Clinical characteristics and antimicrobial therapy of healthcare-associated carbapenem-non-susceptible gram-negative bacterial meningitis: a 16-year retrospective cohort study. BMC Infect Dis 2024; 24:368. [PMID: 38566040 PMCID: PMC10985894 DOI: 10.1186/s12879-024-09237-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 03/19/2024] [Indexed: 04/04/2024] Open
Abstract
OBJECTIVE Healthcare-associated Gram-negative bacterial meningitis is a substantial clinical issue with poor outcomes, especially for neurosurgical patients. Here, we aimed to study the characteristics and treatment options of patients with healthcare-associated carbapenem-non-susceptible (Carba-NS) Gram-negative bacterial meningitis. METHODS This observational cohort study was conducted at a teaching hospital from 2004 to 2019. The clinical characteristics of patients with meningitis with Carba-NS and carbapenem-susceptible (Carba-S) bacilli were compared, and the antimicrobial chemotherapy regimens and outcomes for Carba-NS Gram-negative bacterial meningitis were analyzed. RESULTS A total of 505 patients were included, of whom 83.8% were post-neurosurgical patients. The most common isolates were Acinetobacter spp. and Klebsiella spp., which had meropenem-resistance rates of 50.6% and 42.5%, respectively, and showed a markedly growing carbapenem-resistance trend. Kaplan-Meier curve analysis revealed that Carba-NS Gram-negative bacilli were associated with a significantly higher in-hospital mortality rate (18.8%, 35/186) compared to the Carba-S group (7.4%, 9/122; P = 0.001). For Carba-NS Enterobacterales meningitis, aminoglycoside-based and trimethoprim-sulfamethoxazole-based regimens yielded significantly higher clinical efficacy rates than non-aminoglycoside-based and non-trimethoprim-sulfamethoxazole-based regimens (69.0% vs. 38.7%, P = 0.019 and 81.8% vs. 46.9%, P = 0.036, respectively). For Carba-NS A. baumannii complex meningitis, tetracycline-based (including doxycycline, minocycline, or tigecycline) therapy achieved a significantly higher clinical efficacy rate (62.9%, 22/35) than the non-tetracycline-based therapy group (40.4%, 19/47; P = 0.044). CONCLUSIONS Our findings revealed that Carba-NS Gram-negative bacilli are associated with higher in-hospital mortality in patients with healthcare-associated meningitis. The combination therapies involving particular old antibiotics may improve patients' outcome. TRIAL REGISTRATION This study was registered on the Chinese Clinical Trial Register under ChiCTR2000036572 (08/2020).
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Affiliation(s)
- Jiyan Xu
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, 200040, China
- Key Laboratory of Clinical Pharmacology of Antibiotics, National Heath Commission of People's Republic of China, Shanghai, China
| | - Xiaoling Du
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, 200040, China
- Key Laboratory of Clinical Pharmacology of Antibiotics, National Heath Commission of People's Republic of China, Shanghai, China
| | - Dan Li
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, 200040, China
- Key Laboratory of Clinical Pharmacology of Antibiotics, National Heath Commission of People's Republic of China, Shanghai, China
| | - Pei Li
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, 200040, China
- Key Laboratory of Clinical Pharmacology of Antibiotics, National Heath Commission of People's Republic of China, Shanghai, China
| | - Qinglan Guo
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, 200040, China
- Key Laboratory of Clinical Pharmacology of Antibiotics, National Heath Commission of People's Republic of China, Shanghai, China
| | - Xiaogang Xu
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, 200040, China
- Key Laboratory of Clinical Pharmacology of Antibiotics, National Heath Commission of People's Republic of China, Shanghai, China
| | - Fupin Hu
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, 200040, China
- Key Laboratory of Clinical Pharmacology of Antibiotics, National Heath Commission of People's Republic of China, Shanghai, China
| | - Minggui Wang
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, 200040, China.
- Key Laboratory of Clinical Pharmacology of Antibiotics, National Heath Commission of People's Republic of China, Shanghai, China.
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Wang Q, Wang Y, Yang Y, Kong Y, Peng Y. The value of elevated cerebrospinal fluid lactate concentrations in post-neurosurgical bacterial meningitis. BMC Neurol 2023; 23:377. [PMID: 37864165 PMCID: PMC10588014 DOI: 10.1186/s12883-023-03428-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 10/06/2023] [Indexed: 10/22/2023] Open
Abstract
Bacterial meningitis is a serious complication after neurosurgery and has a high mortality rate. Early diagnosis and timely treatment are crucial or will have disastrous consequences. The classic triad of bacterial meningitis lacks sensitivity and specificity. Therefore, the diagnosis of post-neurosurgical bacterial meningitis relies on cerebrospinal fluid. But traditional cerebrospinal fluid parameters are not completely reliable in diagnosing post-neurosurgical bacterial meningitis. Previous studies have found that CSF lactate concentration is related to bacterial meningitis. But, after the craniocerebral operation, the cerebrospinal fluid of most patients is bloody. Whether red blood cells interfere with diagnosing PNBM based on lactate concentration is limited. In the current study, we further analysis on whether red blood cells interfere with diagnosing PNBM based on lactate concentration. This study aimed to investigate the value of cerebrospinal fluid lactate concentrations in post-neurosurgical bacterial meningitis. A prospective observational study was performed on 62 patients at Kunshan First People's Hospital's intensive care unit affiliated with Jiangsu University. We found that erythrocytes do not affect cerebrospinal fluid lactate, and elevated lactate concentrations can be used as a marker for postoperative bacterial meningitis.
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Affiliation(s)
- Qin Wang
- Intensive Care Unit, The First People ' s Hospital of Kunshan Affiliated to JiangSu University, Kunshan, 215300, Jiangsu, P.R. China
| | - YongFang Wang
- Intensive Care Unit, The First People ' s Hospital of Kunshan Affiliated to JiangSu University, Kunshan, 215300, Jiangsu, P.R. China
| | - Yan Yang
- Intensive Care Unit, The First People ' s Hospital of Kunshan Affiliated to JiangSu University, Kunshan, 215300, Jiangsu, P.R. China
| | - YanXi Kong
- Intensive Care Unit, The First People ' s Hospital of Kunshan Affiliated to JiangSu University, Kunshan, 215300, Jiangsu, P.R. China
| | - Yuan Peng
- Intensive Care Unit, The First People ' s Hospital of Kunshan Affiliated to JiangSu University, Kunshan, 215300, Jiangsu, P.R. China.
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5
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Sipahi OR, Akyol D, Ormen B, Cicek-Senturk G, Mermer S, Onal U, Amer F, Saed MA, Ozdemir K, Tukenmez-Tigen E, Oztoprak N, Altin U, Kurtaran B, Popescu CP, Sakci M, Suntur BM, Gautam V, Sharma M, Kaya S, Akcil EF, Kaya S, Turunc T, Ergen P, Kandemir O, Cesur S, Bardak-Ozcem S, Ozgiray E, Yurtseven T, Erdem HA, Sipahi H, Arda B, Pullukcu H, Tasbakan M, Yamazhan T, Aydemir S, Ulusoy S. Empirical cefepime+vancomycin versus ceftazidime+vancomycin versus meropenem+vancomycin in the treatment of healthcare-associated meningitis: results of the multicenter ephesus study. BMC Infect Dis 2023; 23:639. [PMID: 37770836 PMCID: PMC10540455 DOI: 10.1186/s12879-023-08596-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 09/11/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Herein, we analyzed the efficacy of main antibiotic therapy regimens in the treatment of healthcare-associated meningitis (HCAM). MATERIALS/METHODS This retrospective cohort study was conducted in 18 tertiary-care academic hospitals Turkey, India, Egypt and Romania. We extracted data and outcomes of all patients with post-neurosurgical meningitis cases fulfilling the study inclusion criteria and treated with empirical therapy between December 2006-September 2018. RESULTS Twenty patients in the cefepime + vancomycin-(CV) group, 31 patients in the ceftazidime + vancomycin-(CFV) group, and 119 patients in the meropenem + vancomycin-(MV) group met the inclusion criteria. The MV subgroup had a significantly higher mean Glasgow Coma Score, a higher rate of admission to the intensive care unit within the previous month, and a higher rate of antibiot herapy within the previous month before the meningitis episode (p < 0.05). Microbiological success on Day 3-5, end of treatment (EOT) clinical success (80% vs. 54.8%% vs 57.9%), and overall success (EOT success followed by one-month survival without relapse or reinfection 65% vs. 51.6% vs. 45.3%), EOT all cause mortality (ACM) and day 30 ACM (15% vs. 22.6% vs. 26%) did not differ significantly (p > 0.05) among the three cohorts. No regimen was effective against carbapenem-resistant bacteria, and vancomycin resulted in an EOT clinical success rate of 60.6% in the methicillin-resistant staphylococci or ampicillin-resistant enterococci subgroup (n = 34). CONCLUSIONS Our study showed no significant difference in terms of clinical success and mortality among the three treatment options. All regimens were ineffective against carbapenem-resistant bacteria. Vancomycin was unsuccessful in approximately 40% of cases involving methicillin-resistant staphylococci or ampicillin-resistant enterococci.
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Affiliation(s)
- Oguz Resat Sipahi
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ege University, Izmir, Turkey
- Department of Infectious Diseases, Bahrain Oncology Center, King Hamad University Hospital, Muharraq, Bahrain
| | - Deniz Akyol
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ege University, Izmir, Turkey.
- Infectious Diseases Clinic, Kagizman State Hospital, Kagizman, Kars, Turkey.
| | - Bahar Ormen
- Infectious Diseases and Clinical Microbiology Clinic, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Gonul Cicek-Senturk
- Infectious Diseases and Clinical Microbiology Clinic, SB Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Sinan Mermer
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ege University, Izmir, Turkey
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ekonomi University, Izmir, Turkey
| | - Ugur Onal
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ege University, Izmir, Turkey
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Uludag University, Bursa, Turkey
| | | | | | - Kevser Ozdemir
- Department of Infectious Diseases and Clinical Microbiology, Pamukkale University, Denizli, Turkey
| | - Elif Tukenmez-Tigen
- Department of Infectious Diseases and Clinical Microbiology, Marmara University, Istanbul, Turkey
| | - Nefise Oztoprak
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Uludag University, Bursa, Turkey
- Infectious Diseases and Clinical Microbiology Clinic, Antalya Education and Research Hospital, Antalya, Turkey
| | - Ummugulsum Altin
- Infectious Diseases and Clinical Microbiology Clinic, Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Behice Kurtaran
- Department of Infectious Diseases and Clinical Microbiology, Cukurova University, Adana, Turkey
| | - Corneliu Petru Popescu
- Dr Victor Babes Clinical Hospital of Infectious and Tropical Diseases, Bucharest, Romania
| | - Mustafa Sakci
- Medical Student, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Bedia Mutay Suntur
- Infectious Diseases and Clinical Microbiology Clinic, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Vikas Gautam
- Post-Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Megha Sharma
- Department of Microbiology, All India Institute of Medical Sciences (AIIMS), Bilaspur, Himachal Pradesh, India
| | - Safak Kaya
- Infectious Diseases and Clinical Microbiology Clinic, Gazi Yasargil Education and Research Hospital, Diyarbakir, Turkey
| | - Eren Fatma Akcil
- Department of Anaesthesiology and Reanimation, Istanbul University, Istanbul, Turkey
| | - Selcuk Kaya
- Department of Infectious Diseases and Clinical Microbiology, Medical Faculty, Karadeniz Technical University, Trabzon, Turkey
| | - Tuba Turunc
- Department of Infectious Diseases and Clinical Microbiology, Baskent University, Adana, Turkey
| | - Pınar Ergen
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Medeniyet University, Goztepe Educational and Research Hospital, Istanbul, Turkey
| | - Ozlem Kandemir
- Department of Infectious Diseases and Clinical Microbiology, Mersin University School of Medicine, Mersin, Turkey
| | - Salih Cesur
- Infectious Diseases and Clinical Microbiology Clinic, Ankara Training Hospital, Ankara, Turkey
| | - Selin Bardak-Ozcem
- Department of Infectious Diseases and Clinical Microbiology, Dr. Burhan Nalbantoğlu State Hospital, Nicosia, Northern Cyprus
| | - Erkin Ozgiray
- Department of Neurosurgery, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Taskın Yurtseven
- Department of Neurosurgery, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Huseyin Aytac Erdem
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ege University, Izmir, Turkey
| | | | - Bilgin Arda
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Hüsnü Pullukcu
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Meltem Tasbakan
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Tansu Yamazhan
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Sohret Aydemir
- Department of Clinical Microbiology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Sercan Ulusoy
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ege University, Izmir, Turkey
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Kar M, Jamwal A, Dubey A, Sahu C, Patel SS. Bacterial Meningitis among Intracranial Surgery Patients at a University Hospital in Northern India. Indian J Crit Care Med 2022; 26:1244-1252. [PMID: 36755630 PMCID: PMC9886024 DOI: 10.5005/jp-journals-10071-24363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 10/25/2022] [Indexed: 12/02/2022] Open
Abstract
Background Cerebrospinal infections are the cause of poor prognosis among post-neurosurgery patients owing to delay in improvement of neurological functions, leading to increased length of hospital stay, proceeding to disability or death. Methods and materials This retrospective observational study was performed at a tertiary care center in Northern India, where all patients with bacterial cerebrospinal infections from July 2019 to July 2022 were evaluated for post-neurosurgery cerebrospinal shunt infections, and all demographic data and risk factors were extracted from the hospital information system (HIS). Results The study includes 150 (150/1986, 7.55%) culture-confirmed cases of bacterial meningitis out of 1986 cases of suspected bacterial meningitis patients. Ninety-six (96/150, 64.0%) post-neurosurgery patients with cerebrospinal fluid (CSF) leaks were managed using external ventricular drain (EVD) or ventriculoperitoneal (VP) shunt. Seventy-four (74/96, 77.08%) patients were managed only on EVD, whereas 22 (22/96, 22.92%) patients were managed only on VP shunt. Eighty-two (82/96, 85.4%) multidrug-resistant microorganisms (MDROs) were isolated and 70 (70/82, 85.36%) were gram-negative bacteria, of which 56 (56/74, 75.68%) gram-negative bacteria showed extended-spectrum beta-lactamase (ESBL)-producing character in those with an EVD, 14 (14/22, 63.63%) with a VP shunt. Among gram-negative bacteria, Acinetobacter baumannii showed high rates of resistance: 21 (21/23, 91.30%) and 8 (8/8, 100%) were ESBL-producing A. baumannii in patients managed on EVD and VP shunt, respectively. Conclusion This study determines the risk factors, the spectrum of pathogenic microorganisms, multidrug resistance, and the nature of intracranial lesions isolated among the patients who developed bacterial cerebrospinal infections in post-neurosurgery patients. How to cite this article Kar M, Jamwal A, Dubey A, Sahu C, Patel SS. Bacterial Meningitis among Intracranial Surgery Patients at a University Hospital in Northern India. Indian J Crit Care Med 2022;26(12):1244-1252.
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Affiliation(s)
- Mitra Kar
- Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Ashima Jamwal
- Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Akanksha Dubey
- Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Chinmoy Sahu
- Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India,Chinmoy Sahu, Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India, Phone: +91 8004904515, e-mail:
| | - Sangram Singh Patel
- Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Valdoleiros SR, Torrão C, Freitas LS, Mano D, Gonçalves C, Teixeira C. Nosocomial meningitis in intensive care: a 10-year retrospective study and literature review. Acute Crit Care 2022; 37:61-70. [PMID: 35081705 PMCID: PMC8918708 DOI: 10.4266/acc.2021.01151] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 11/08/2021] [Indexed: 12/03/2022] Open
Abstract
Background Nosocomial meningitis is a medical emergency that requires early diagnosis, prompt initiation of therapy, and frequent admission to the intensive care unit (ICU). Methods A retrospective study was conducted in adult patients diagnosed with nosocomial meningitis who required admission to the ICU between April 2010 and March 2020. Meningitis/ventriculitis and intracranial infection were defined according to Centers for Disease Control and Prevention guidelines. Results An incidence of 0.75% of nosocomial meningitis was observed among 70 patients. The mean patient age was 59 years and 34% were ≥65 years. Twenty-two percent of patients were in an immunocompromised state. A clear predisposing factor for nosocomial meningitis (traumatic brain injury, basal skull fracture, brain hemorrhage, central nervous system [CNS] invasive procedure or device) was present in 93% of patients. Fever was the most frequent clinical feature. A microbiological agent was identified in 30% of cases, of which 27% were bacteria, with a predominance of Gram-negative over Gram-positive. Complications developed in 47% of cases, 24% of patients were discharged with a Glasgow coma scale <14, and 37% died. There were no clear clinical predictors of complications. Advanced age (≥65 years old) and the presence of complications were associated with higher hospital mortality. Conclusions Nosocomial meningitis in critical care has a low incidence rate but high mortality and morbidity. In critical care patients with CNS-related risk factors, a high level of suspicion for meningitis is warranted, but diagnosis can be hindered by several confounding factors.
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Affiliation(s)
- Sofia R Valdoleiros
- Department of Infectious Diseases, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Cristina Torrão
- Department of Intensive Care, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Laura S Freitas
- Department of Emergency, Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal
| | - Diana Mano
- Department of Intensive Care, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Celina Gonçalves
- Department of Intensive Care, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Carla Teixeira
- Department of Intensive Care, Centro Hospitalar Universitário do Porto, Porto, Portugal.,Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal.,CriticalMed Cintesis, Centro de Investigação em Tecnologias e Serviços de Saúde, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
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8
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Kafshnouchi M, Safari M, Khodavirdipour A, Bahador A, Hashemi SH, Alikhani MS, Saidijam M, Alikhani MY. Molecular Detection of blaOXA-type
Carbapenemase Genes and Antimicrobial Resistance Patterns among Clinical Isolates of Acinetobacter baumannii. Glob Med Genet 2021; 9:118-123. [PMID: 35707776 PMCID: PMC9192170 DOI: 10.1055/s-0041-1740019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 10/18/2021] [Indexed: 12/02/2022] Open
Abstract
Acinetobacter baumannii
is a bacterium found in most places, especially in clinics and hospitals, and an important agent of nosocomial infections. The presence of class D enzymes such as OXA-type carbapenemases in
A. baumannii
is proven to have a key function in resistance to carbapenem. The aim of the current study is to determine the
blaOXA
-type
carbapenemase genes and antimicrobial resistance among clinically isolated samples of
A. baumannii.
We assessed 100 clinically isolated specimens of
A. baumannii
from patients in intensive care units of educational hospitals of Hamadan, West of Iran. The
A. baumannii
isolates' susceptibility to antibiotics was performed employing disk diffusion method. Multiplex polymerase chain reaction was used to identify the
bla
OXA-24-like
,
bla
OXA-23-like
,
bla
OXA-58-like
, and
bla
OXA-51-like
genes.
The bla
OXA-23-like
,
bla
OXA-24-like,
and
bla
OXA-58-like
genes' prevalence were found to be 84, 58, and 3%, respectively. The highest coexistence of the genes was for
bla
OXA-51/23
(84%) followed by
bla
OXA-51/24-like
(58%). The
bla
OXA-51/23-like
pattern of genes is a sort of dominant gene in resistance in
A. baumannii
from Hamadan hospitals. The highest resistance to piperacillin (83%) and ciprofloxacin (81%) has been observed in positive isolates of
bla
OXA-23-like
. The
A. baumannii
isolates with
bla
OXA-58-like
genes did not show much resistance to antibiotics. Based on the results of the phylogenetic tree analysis, all isolates have shown a high degree of similarity. This study showed the high frequency of
OXA
-type carbapenemase genes among
A. baumannii
isolates from Hamadan hospitals, Iran. Thus, applying an appropriate strategy to limit the spreading of these strains and also performing new treatment regimens are necessary.
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Affiliation(s)
| | - Marzieh Safari
- Department of Microbiology, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Amir Khodavirdipour
- Department of Biology, Faculty of Natural Sciences, University of Tabriz, Tabriz, Iran
| | - Abbas Bahador
- Department of Microbiology, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Hamid Hashemi
- Department of Infectious Diseases, Hamadan University of Medical Sciences, Hamadan, Iran
| | | | - Massoud Saidijam
- Research Center for Molecular Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
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Chang JB, Chen Y, Wang H, Ma X, Zhang X, Wu H, Ma B, Zuo W, Ma W, Wang R, Wei J. Combined Strategy for Post-Operative Patients with Central Nervous System Infections Caused by Extensively Drug-Resistant/Pan-Drug–Resistant Acinetobacter baumannii: A Retrospective Study. Surg Infect (Larchmt) 2020; 21:853-858. [PMID: 32302500 DOI: 10.1089/sur.2019.341] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Jian-bo Chang
- Department of Neurosurgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Yihao Chen
- Department of Neurosurgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - He Wang
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaojun Ma
- Department of Infectious Disease, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiao Zhang
- Department of Neurosurgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Hao Wu
- Department of Neurosurgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Baitao Ma
- Department of Neurosurgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Wei Zuo
- Department of Pharmacy, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Wenbin Ma
- Department of Neurosurgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Renzhi Wang
- Department of Neurosurgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Junji Wei
- Department of Neurosurgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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Wang Y, Li Z, Cao X, Zhou C, Jin Y. Postoperative antibiotic management strategy for febrile patient with posterior cranial fossa tumor resection: Retrospective clinical study. J Clin Neurosci 2020; 80:80-86. [PMID: 33099373 DOI: 10.1016/j.jocn.2020.07.066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/21/2020] [Accepted: 07/27/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Postoperative fever (POF), associated with posterior cranial fossa (PCF) surgery, occurs commonly and is a potential intracranial infection indicator of perioperative antibiotics prolongation and advancement. The existing prophylactic approaches to balancing the risk between intracranial infection and antibiotics abuse are debatable. METHODS We retrospectively assessed 100 patients subjected to PCF tumor resection between December 2015 and December 2018 at a single institution. Forty febrile patients were selected for further analysis. Of them, 16 received basic and 24 advanced antibiotics and were subjected to prophylactic antibiotic assessment. RESULTS The total POF rate of PCF tumor resection was 49.4%. POF occurred from day 1 to day 5, along with the abnormalities of cerebrospinal fluid (CSF) profiles and the mild meningeal irritation symptom. CSF cultures of all selected patients were negative. In the comparison between the basic and advanced antibiotic therapy, we found no statistically significant differences in the results of the average and dynamic analysis of the body temperature and CSF profiles. Negative results of outcome studies were also obtained in the duration of fever, duration of hospitalization, and total hospitalization expenses. However, the expenses were substantially increased in the advanced antibiotic treatment. CONCLUSIONS Although POF is a common symptom after PCF tumor resection, definite intracranial infection is rare. A high body temperature and significant abnormal CSF profiles at an early stage may not be a specific and sufficient indicator of intracranial infection to upgrade antibiotics therapy when standard prophylactic protocols have been accurately achieved.
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Affiliation(s)
- Yida Wang
- Department of Neurosurgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Zhen Li
- Department of Neurosurgery, Jingjiang People's Hospital, Jingjiang, Jiangsu 214500, China
| | - Xiangyuan Cao
- Department of Neurosurgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Chengcheng Zhou
- Department of Neurosurgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Yi Jin
- Department of Neurosurgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China.
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Polymyxin for the treatment of intracranial infections of extensively drug-resistant bacteria in children after neurosurgical operation. World J Pediatr 2020; 16:528-532. [PMID: 32193830 DOI: 10.1007/s12519-020-00350-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 02/25/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Increased meningitis caused by extensively drug-resistant bacillary presents a significant challenge in antibiotic selection. The aim of our study was to evaluate the efficacy and safety of polymyxin in the treatment of post-neurosurgical meningitis due to the extensively drug-resistant bacillary in children. METHODS We performed a retrospective study on post-neurosurgical meningitis caused by the extensively drug-resistant bacillary in children, who were treated with polymyxin for ≥ 3 days. RESULTS Among five post-neurosurgical meningitis cases that were included, the children were infected by Acinetobacter baumannii (n = 3), Klebsiella pneumonia (n = 1), and Pseudomonas aeruginosa (n = 1). The drug susceptibility test showed that they were extensively drug-resistant bacillary. Two patients received intravenous polymyxin E. Three children received intravenous combined with intraventricular injection of polymyxin B. One patient infected by Klebsiella pneumonia eventually died of septic shock. No serious adverse effects of polymyxin were observed. CONCLUSIONS Polymyxin is a safe and effective therapy for post-neurosurgical, multidrug-resistant bacillary meningitis in children.
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Li Y, Wang R, Song PX, Ge H, Li YC, Ji CL, Jiang YH. Impact of an educational program on reducing health care-associated meningitis or ventriculitis in the neurosurgical intensive care unit. Am J Infect Control 2020; 48:621-625. [PMID: 31759767 DOI: 10.1016/j.ajic.2019.10.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 10/11/2019] [Accepted: 10/11/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Health care-associated meningitis or ventriculitis (HCAMV) is a serious complication in different neurosurgical procedures and is associated with significant morbidity and mortality. We aimed to investigate whether an educational intervention program could reduce the HCAMV incidence in patients undergoing postsurgery external ventricular drainage and wound management. METHODS We enrolled 2,904 patients from the neurosurgery intensive care unit between January 1, 2016 and December 31, 2018. The medical staff undertook an educational program developed by a multidisciplinary team on correct external ventricular drainage insertion and maintenance. The program included a 9-page self-learning module on the HCAMV risk factors and operational improvements. Each participant completed a pre- and posttest on their HCAMV knowledge. RESULTS We found that 38 of 693 (5.48%) patients presented with infection in the preintervention 9-month period. In the 27-month postintervention period, the proportion of HCAMV incidence dropped by 52.19% (P < .0001) to 58 of 2,211 (2.62%) patients. CONCLUSIONS Educational intervention aimed at the neurosurgery intensive care unit staff could significantly reduce the HCAMV rate, leading to a significant decline in the cost, morbidity, and mortality caused by neurosurgical procedures.
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Affiliation(s)
- Yang Li
- Department of Nosocomial Infection Control, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Jiangsu, PR China
| | - Rong Wang
- Department of Neurology Intensive Care Unit, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Jiangsu, PR China
| | - Pei-Xin Song
- Department of Infectious Diseases, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Jiangsu, PR China
| | - Hai Ge
- Department of Nosocomial Infection Control, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Jiangsu, PR China
| | - Yi-Chen Li
- Department of Pharmacy, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Jiangsu, PR China
| | - Cui-Ling Ji
- Department of Neurology Intensive Care Unit, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Jiangsu, PR China
| | - Yi-Hong Jiang
- Department of Nosocomial Infection Control, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Jiangsu, PR China.
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13
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Lotfi R, Ines B, Aziz DM, Mohamed B. Cerebrospinal Fluid Lactate as an Indicator for Post-neurosurgical Bacterial Meningitis. Indian J Crit Care Med 2019; 23:127-130. [PMID: 31097888 PMCID: PMC6487616 DOI: 10.5005/jp-journals-10071-23134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective To evaluate the interest of cerebrospinal fluid (CSF) lactate assay for the diagnosis of post-neurosurgical bacterial meningitis (PBM). Methods We conducted at our neurosurgical resuscitation unit a prospective study of patients who underwent elective or emergency craniotomy. Lumbar puncture was performed in all patients who had clinical suspicion of PBM for CSF culture and cytological and chemical analysis (glucose, protein, lactate). The diagnosis of PBM is made according to the criteria proposed by the Center for Disease Control and Prevention (CDC). Receiver Operating Characteristic (ROC) was used to determine the diagnostic accuracy of CSF lactate. Results 72 patients were studied and only 32 of them had the clinical and biological criteria of the diagnosis of PBM. Median CSF lactate was 6.18 mmol/L for PBM vs 2.63 mmol/L for no PBM (p < 0.001). CSF lactate may predict the presence PBM, with a AUC of 0.98 and NPV of 99.1. The analysis of Youden's index also confirms the good diagnostic power of CSF lactate with a value of 83 at a cut-off value of 4 mmol/L and a sensitivity of 92.3% and specificity of 91.6%. Conclusion Our study shows that the CSF lactate as an indicator for PBM. It is a fast and simple test that can help the clinician to optimize the management of PBM and decrease premature cessation of antibiotics. How to cite this article Lotfi R, Ines B, et al. Cerebrospinal Fluid Lactate as an Indicator for Post-neurosurgical Bacterial Meningitis. Indian J Crit Care Med 2019;23(3):127-130.
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Affiliation(s)
- Rebai Lotfi
- Department of Anesthesiology and Critical Care Medicine, Burns and Trauma Center, Tunisia
| | - Boussaidi Ines
- Department of Anesthesiology and Critical Care Medicine, Burns and Trauma Center, Tunisia
| | - Daghmouri M Aziz
- Department of Anesthesiology and Critical Care Medicine, Burns and Trauma Center, Tunisia
| | - Badri Mohamed
- Department of Neurosurgery, Burns and Trauma Center, Tunisa
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Dickerson JC, Hidalgo JA, Smalley ZS, Shiflett JM. Diffuse vasospasm after transcortical temporal lobectomy for intractable epilepsy. Acta Neurochir (Wien) 2018; 160:1883-1887. [PMID: 29987392 DOI: 10.1007/s00701-018-3606-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 06/25/2018] [Indexed: 11/26/2022]
Abstract
Cerebral delayed ischemia due to arterial vasospasm is a rare complication following epilepsy surgery. Here we report the third known case and first of diffuse vasospasm. A 48-year-old woman underwent a transcortical anterior left temporal lobectomy. Eleven days later, she had new-onset expressive aphasia with narrowing of the anterior, middle, and posterior cerebral arteries, and increased velocities via transcranial Doppler. She was treated with fluids, nimodipine, and permissive hypertension. At 6 months, her speech was near baseline. Cerebral vasospasm may represent a rare cause of morbidity after anterior temporal lobectomy; a literature review on the subject is presented.
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Affiliation(s)
- James Charles Dickerson
- Department of Neurosurgery, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA.
| | - Joaquin Andres Hidalgo
- Department of Neurosurgery, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA
| | - Zachary Stidham Smalley
- Department of Neurosurgery, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA
| | - James Mason Shiflett
- Department of Neurosurgery, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA
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Bodilsen J, Brouwer MC, Kjærgaard N, Sirks MJ, van der Ende A, Nielsen H, van de Beek D. Community-acquired meningitis in adults caused by Escherichia coli in Denmark and The Netherlands. J Infect 2018; 77:25-29. [PMID: 29859862 DOI: 10.1016/j.jinf.2018.05.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES We aimed to examine risk factors, presenting characteristics and complications of Escherichia coli community-acquired bacterial meningitis in adults. METHODS Observational cohort study of adults > 16 years of age with cerebrospinal fluid culture-positive E. coli meningitis in Denmark and the Netherlands. Exclusion criteria were primary brain abscess, previous neurosurgery and nosocomial infections. We analysed baseline characteristics, concomitant infections and neurological complications. Outcome was assessed using the Glasgow Outcome Scale score (GOS) at discharge with GOS 1-4 categorised as unfavourable outcome. RESULTS We identified 36 patients with a median age of 69 years (interquartile range 61-83) of whom 15 (42%) were females. Immuno-compromise was present in 11 (31%) patients. Nineteen (53%) patients had concomitant infections consisting of urinary tract infections in 13 (36%), pneumonia in three (9%) and septic arthritis in two (6%). Bacteraemia with E. coli was found in 26 of 34 (76%) patients. Thirteen patients died (36%) and unfavourable outcome at discharge occurred in 23 (64%). Deaths were attributed to systemic complications in 12 (92%) patients. CONCLUSION Community-acquired E. coli meningitis in adults is a severe disease that primarily occurs in elderly patients with concomitant infections and an immunocompromised state. Outcome is often poor and mainly caused by systemic complications.
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Affiliation(s)
- Jacob Bodilsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark.
| | - Matthijs C Brouwer
- Department of Neurology, Amsterdam Neuroscience, Academic Medical Centre, Amsterdam, The Netherlands
| | - Nicolai Kjærgaard
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
| | - Marc J Sirks
- Department of Neurology, Amsterdam Neuroscience, Academic Medical Centre, Amsterdam, The Netherlands
| | - Arie van der Ende
- Department of Medical Microbiology, Academic Medical Center, Amsterdam Infection & Immunity Institute, Amsterdam, The Netherlands; Netherlands Reference Laboratory for Bacterial Meningitis, Academic Medical Center, Amsterdam, The Netherlands
| | - Henrik Nielsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
| | - Diederik van de Beek
- Department of Neurology, Amsterdam Neuroscience, Academic Medical Centre, Amsterdam, The Netherlands
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Chang JB, Wu H, Wang H, Ma BT, Wang RZ, Wei JJ. Prevalence and antibiotic resistance of bacteria isolated from the cerebrospinal fluid of neurosurgical patients at Peking Union Medical College Hospital. Antimicrob Resist Infect Control 2018; 7:41. [PMID: 29568514 PMCID: PMC5859784 DOI: 10.1186/s13756-018-0323-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 02/20/2018] [Indexed: 01/19/2023] Open
Abstract
Background Postoperative central nervous system infections (PCNSIs) represent a serious complication, and the timely use of antibiotics guided by the identification of the causative pathogens and their antibiotic sensitivities is essential for treatment. However, there are little data regarding the prevalence of PCNSI pathogens in China. The aim of this study is to investigate the features of pathogens in patients with PCNSIs, which could help clinicians to choose the appropriate empirical antibiotic therapy. Methods We retrospectively examined the positive CSF cultures in patients who underwent craniotomy between January 2010 and December 2015. We collected data, including demographic characteristics, type of neurosurgery, laboratory data, causative organisms and antimicrobial susceptibility testing results. Results A total of 62 patients with 90 isolates out of 818 patients with 2433 CSF culture samples were available for data analysis. The estimated incidence and culture-positive rate of PCNSIs were approximately 0.9 and 7.5%, respectively. The predominant organism was coagulase-negative staphylococci, of which most were methicillin-resistant coagulase-negative staphylococci (MRCoNS). All were susceptible to vancomycin, linezolid, rifampicin and amoxicillin-clavulanate. Acinetobacter baumannii was the most frequent causative Gram-negative agent and was resistant to 12 out of 18 antimicrobials tested. The sensitivity rates for tigecycline and minocycline were only 40 and 33%, respectively. Conclusion PCNSIs could lead to high mortality. Although the MRCoNS were the predominant organism, the management of Acinetobacter baumannii was a major clinical challenge with few effective antimicrobials in PCNSIs.
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Affiliation(s)
- Jian-Bo Chang
- Department of Neurosurgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No.1 Shuaifuyuan, Dongcheng District, Beijing, 100730 China
| | - Hao Wu
- Department of Neurosurgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No.1 Shuaifuyuan, Dongcheng District, Beijing, 100730 China
| | - He Wang
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No.1 Shuaifuyuan, Dongcheng District, Beijing, 100730 China
| | - Bai-Tao Ma
- Department of Neurosurgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No.1 Shuaifuyuan, Dongcheng District, Beijing, 100730 China
| | - Ren-Zhi Wang
- Department of Neurosurgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No.1 Shuaifuyuan, Dongcheng District, Beijing, 100730 China
| | - Jun-Ji Wei
- Department of Neurosurgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No.1 Shuaifuyuan, Dongcheng District, Beijing, 100730 China
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Guo W, Guo SC, Li M, Li LH, Qu Y. Successful treatment of extensively drug-resistant Acinetobacter baumannii ventriculitis with polymyxin B and tigecycline- a case report. Antimicrob Resist Infect Control 2018; 7:22. [PMID: 29456841 PMCID: PMC5813425 DOI: 10.1186/s13756-018-0313-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 02/07/2018] [Indexed: 11/29/2022] Open
Abstract
Background Acinetobacter baumannii nosocomial ventriculitis/meningitis, especially those due to drug-resistant strains, has substantially increased over recent years. However, limited therapeutic options exist for the Acinetobacter baumannii ventriculitis/meningitis because of the poor penetration rate of most antibiotics through the blood-brain barrier. Case presentation A 57-year-old male patient developed ventriculitis from an extensively drug-resistant strain of Acinetobacter baumannii after the decompressive craniectomy for severe traumatic brain injury. The patient was successfully treated with intraventricular and intravenous polymyxin B together with intravenous tigecycline. Conclusions The case illustrates intraventricular polymyxin B can be a therapeutic option against extensively drug-resistant Acinetobacter baumannii ventriculitis.
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Affiliation(s)
- Wei Guo
- Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710038 China
| | - Shao-Chun Guo
- Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710038 China
| | - Min Li
- Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710038 China
| | - Li-Hong Li
- Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710038 China
| | - Yan Qu
- Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710038 China
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Sam JE, Lim CL, Sharda P, Wahab NA. The Organisms and Factors Affecting Outcomes of External Ventricular Drainage Catheter-Related Ventriculitis: A Penang Experience. Asian J Neurosurg 2018; 13:250-257. [PMID: 29682017 PMCID: PMC5898088 DOI: 10.4103/ajns.ajns_150_16] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Introduction: Ventriculostomy-related infection (VRI) from external ventricular drain (EVD) insertion is a common complication and carries a high mortality rate. Choice of empiric antibiotics depends on the institutions common causative organisms and their susceptibility. We determined risk factors for mortality in patients with VRI, the common organisms causing VRI, and the rate of EVD-related VRI at our institution. Methods: Medical records and operative data of patients with cerebrospinal fluid positive cultures with an EVD inserted from 2012 to 2015 were traced. Forty-five patients with EVD-related VRI were included in the study. Results: The overall rate of VRI was 6.3%, and the overall mortality rate due to VRI was 48.9%. Acinetobacter baumannii was the most common organism causing VRI (14 patients, 29.2%) with a mortality rate of 64.3%. Only 14.3% of A. baumannii are sensitive to meropenem and imipenem. We found that patients that had a decompressive craniectomy (DC) had a lower mortality rate (P = 0.042) and patients with a longer duration of the EVD being in place before the diagnosis of VRI had poor outcome (P = 0.040). Multivariate logistic regression was performed and we found that the use of steroid (P = 0.014), Pseudomonas aeruginosa infection (P = 0.010), multiple organism infection (P = 0.017), lower Glasgow Coma Scale (P = 0.043), and a longer duration the EVD was in place before the diagnosis of VRI (P = 0.008) were related with higher mortality. Conclusion: VRI mortality rate is high with an alarming resistance pattern seen in Acinetobacter VRI. EVDs should be removed as soon as feasible, and DC may be offered to patients with severe ventriculitis or meningitis.
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Affiliation(s)
- Jo Ee Sam
- Department of Neurosurgery, Penang General Hospital, Penang, Malaysia
| | - Chee Loon Lim
- Department of Infectious Diseases, Penang General Hospital, Penang, Malaysia
| | - Priya Sharda
- Department of Neurosurgery, Penang General Hospital, Penang, Malaysia
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Hernández Ortiz OH, García García HI, Muñoz Ramírez F, Cardona Flórez JS, Gil Valencia BA, Medina Mantilla SE, Moreno Ochoa MJ, Sará Ochoa JE, Jaimes F. Development of a prediction rule for diagnosing postoperative meningitis: a cross-sectional study. J Neurosurg 2018; 128:262-271. [DOI: 10.3171/2016.10.jns16379] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVEDiagnosing nosocomial meningitis (NM) in neurosurgical patients is difficult. The standard CSF test is not optimal and when it is obtained, CSF cultures are negative in as many as 70% of cases. The goal of this study was to develop a diagnostic prediction rule for postoperative meningitis using a combination of clinical, laboratory, and CSF variables, as well as risk factors (RFs) for CNS infection.METHODSA cross-sectional study was performed in 4 intensive care units in Medellín, Colombia. Patients with a history of neurosurgical procedures were selected at the onset of febrile symptoms and/or after an increase in acute-phase reactants. Their CSF was studied for suspicion of infection and a bivariate analysis was performed between the dependent variable (confirmed/probable NM) and the identified independent variables. Those variables with a p value ≤ 0.2 were fitted in a multiple logistic regression analysis with the same dependent variable. After determining the best model according to its discrimination and calibration, the β coefficient for each selected dichotomized variable obtained from the logistic regression model was used to construct the score for the prediction rule.RESULTSAmong 320 patients recruited for the study, 154 had confirmed or probable NM. Using bivariate analysis, 15 variables had statistical associations with the outcome: aneurysmal subarachnoid hemorrhage (aSAH), traumatic brain injury, CSF leak, positioning of external ventricular drains (EVDs), daily CSF draining via EVDs, intraventricular hemorrhage, neurological deterioration, age ≥ 50 years, surgical duration ≥ 220 minutes, blood loss during surgery ≥ 200 ml, C-reactive protein (CRP) ≥ 6 mg/dl, CSF/serum glucose ratio ≤ 0.4 mmol/L, CSF lactate ≥ 4 mmol/L, CSF leukocytes ≥ 250 cells, and CSF polymorphonuclear (PMN) neutrophils ≥ 50%. The multivariate analysis fitted a final model with 6 variables for the prediction rule (aSAH diagnosis: 1 point; CRP ≥ 6 mg/dl: 1 point; CSF/serum glucose ratio ≤ 0.4 mmol/L: 1 point; CSF leak: 1.5 points; CSF PMN neutrophils ≥ 50%: 1.5 points; and CSF lactate ≥ 4 mmol/L: 4 points) with good calibration (Hosmer-Lemeshow goodness of fit = 0.71) and discrimination (area under the receiver operating characteristic curve = 0.94).CONCLUSIONSThe prediction rule for diagnosing NM improves the diagnostic accuracy in neurosurgical patients with suspicion of infection. A score ≥ 6 points suggests a high probability of neuroinfection, for which antibiotic treatment should be considered. An independent validation of the rule in a different group of patients is warranted.
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Affiliation(s)
- Olga Helena Hernández Ortiz
- 1Academic Group of Clinical Epidemiology (GRAEPIC), School of Medicine, Universidad de Antioquia
- 2Instituto Neurológico de Colombia
- 3Clínica Medellín
| | | | | | | | | | | | | | | | - Fabián Jaimes
- 1Academic Group of Clinical Epidemiology (GRAEPIC), School of Medicine, Universidad de Antioquia
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Habib OB, Srihawan C, Salazar L, Hasbun R. Prognostic Impact of Health Care–Associated Meningitis in Adults with Intracranial Hemorrhage. World Neurosurg 2017; 107:772-777. [DOI: 10.1016/j.wneu.2017.08.118] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 08/16/2017] [Accepted: 08/17/2017] [Indexed: 11/25/2022]
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Oterdoom LH, Marinus Oterdoom DL, Ket JCF, van Dijk JMC, Scholten P. Systematic review of ventricular peritoneal shunt and percutaneous endoscopic gastrostomy: a safe combination. J Neurosurg 2017; 127:899-904. [DOI: 10.3171/2016.8.jns152701] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVEVarious international and national gastrointestinal guidelines take different positions on whether ventriculoperitoneal shunt (VPS) insertion is a contraindication to percutaneous endoscopic gastrostomy (PEG). The objective of this meta-analysis was to try to answer the question of whether VPS insertion is a contraindication to PEG.METHODSA systematic review of the literature was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. Electronic databases PubMed and Embase were searched using variations of the terms “ventriculo-peritoneal shunt” and “percutaneous (endoscopic) gastrostomy.” This search resulted in 70 studies, 9 of which were relevant. These were cross-referenced, and 1 additional study was found, resulting in 10 studies in this systematic review.RESULTSThe 10 relevant studies in adult cohorts included 208 patients. All studies save one were retrospective and, in general, poor quality. Among the studies with relevant data, there were 26 (12.5% of 208 cases) VPS infections and 4 (4.4% of 90 cases) VPSs that malfunctioned. In 137 patients the VPS had been placed before the PEG tube, with a VPS infection rate of 4.4%. More VPS infections occurred among the 55 patients who first had a PEG and a subsequent VPS (21.8%) and in the 16 patients who had simultaneous PEG tube and VPS placement (50%). The heterogeneity of the studies in this analysis prohibited statistical comparisons of the timing of VPS and PEG tube placement.CONCLUSIONSThis systematic review indicated that VPS placement in combination with a PEG has a high but acceptable VPS complication rate. Therefore, VPS insertion should not be considered a contraindication to the placement of a PEG tube. Preferably, a PEG tube should be placed after the VPS. Waiting 7–10 days between VPS insertion and a PEG seems reasonable, but this could not be corroborated in this review.
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Affiliation(s)
- Leendert H. Oterdoom
- 1Department of Gastroenterology and Hepatology, HAGA Ziekenhuis, The Hague
- 4Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, The Netherlands
| | | | | | | | - Pieter Scholten
- 4Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, The Netherlands
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Khan SA, Waqas M, Siddiqui UT, Shamim MS, Nathani KR, Jooma R, Mehmood F. Intrathecal and intraventricular antibiotics for postoperative Gram-negative meningitis and ventriculitis. Surg Neurol Int 2017; 8:226. [PMID: 29026662 PMCID: PMC5629845 DOI: 10.4103/sni.sni_81_17] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 06/01/2017] [Indexed: 11/05/2022] Open
Abstract
Background: Postoperative meningitis is a growing cause of concern, especially with the evolution of multidrug-resistant organism. The authors evaluate the use of intraventricular/intrathecal (IVT/IT) antibiotics for postoperative gram-negative meningitis in patients whom intravenous antibiotics were ineffective. Methods: Medical records were retrospectively reviewed and neurosurgery patients with gram-negative postoperative infection meningitis/ventriculitis were enrolled in the study. Their demographics, hospital course, and outcomes were recorded in a pro forma and analyzed using Statistical Package for the Social Sciences, version 19. Results: The review identified 21 patients with postneurosurgical gram-negative meningitis/ventriculitis who were treated with IVT or IT antibiotics. The most common organism was Acinetobacter species (n = 14; 66%). Amikacin was used in 7 patients, polymyxin B in 9 patients, and colistin in 5 patients. A combination of antibiotics was used in one patient. Cerebrospinal fluid sterility was achieved in all patients with no incidence of relapse. There was a single death, though that was not related to the infectious process as the patient had a massive pulmonary embolism. Conclusion: The findings of this study suggest that IVT and IT antibiotic therapy is a useful option in patients who are nonresponsive to standard intravenous therapy with little or no side effects.
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Affiliation(s)
- Saad Akhtar Khan
- Section of Neurosurgery, The Memon Medical Institute, Karachi, Pakistan
| | - Muhammad Waqas
- Section of Neurosurgery, The Aga Khan University Hospital, Karachi, Pakistan
| | - Usman T Siddiqui
- Section of Neurosurgery, The Aga Khan University Hospital, Karachi, Pakistan
| | | | | | - Rashid Jooma
- Section of Neurosurgery, The Aga Khan University Hospital, Karachi, Pakistan
| | - Faisal Mehmood
- Department of Medicine, The Aga Khan University Hospital, Karachi, Pakistan
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Characteristics of meningitis following transsphenoidal endoscopic surgery: a case series and a systematic literature review. Infection 2017; 45:841-848. [PMID: 28776163 DOI: 10.1007/s15010-017-1056-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 07/28/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Meningitis occurs in 0.8-1.5% of patients undergoing neurosurgery. The aim of the study was to evaluate the characteristics of meningitis after endoscopic endonasal transsphenoidal surgery (EETS) comparing the findings retrieved to those highlighted by literature search. MATERIALS AND METHODS Patients treated by EETS during an 18-year period in the Department of Neurosurgery of 'Federico II' University of Naples were evaluated and included in the study if they fulfilled criteria for meningitis. Epidemiological, demographic, laboratory, and microbiological findings were evaluated. A literature research according to PRISMA methodology completed the study. RESULTS EETS was performed on 1450 patients, 8 of them (0.6%) had meningitis [median age 46 years (range 33-73)]. Endoscopic surgery was performed 1-15 days (median 4 days) before diagnosis. Meningeal signs were always present. CSF examination revealed elevated cells [median 501 cells/μL (range 30-5728)], high protein [median 445 mg/dL (range 230-1210)], and low glucose [median 10 mg/dL (range 1-39)]. CSF culture revealed Gram-negative bacteria in four cases (Klebsiella pneumoniae, Escherichia coli, Alcaligenes spp., and Haemophilus influenzae), Streptococcus pneumoniae in two cases, Aspergillus fumigatus in one case. An abscess occupying the surgical site was observed in two cases. Six cases reported a favorable outcome; two died. Incidence of meningitis approached to 2%, as assessed by the literature search. CONCLUSIONS Incidence of meningitis after EETS is low despite endoscope goes through non-sterile structures; microorganisms retrieved are those present within sinus microenvironment. Meningitis must be suspected in patients with persistent fever and impaired conscience status after EETS.
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Trung NT, Van Son T, Quyen DT, Anh DTV, Sang VV, Lam NX, Manh ND, Duong VP, Cuong BT, Tuyen QD, Chinh NX, Hoan PQ, Van Tong H, Meyer CG, Song LH. Significance of nucleic acid testing in diagnosis and treatment of post-neurosurgical meningitis caused by multidrug-resistant Acinetobacter baumannii: a case report. J Med Case Rep 2016; 10:313. [PMID: 27809900 PMCID: PMC5094039 DOI: 10.1186/s13256-016-1104-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 10/13/2016] [Indexed: 12/12/2022] Open
Abstract
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. Case presentation 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.
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Affiliation(s)
- Ngo Tat Trung
- Department of Molecular Biology, 108 Military Central Hospital, Hanoi, Vietnam.,Vietnamese-German Centre for Medical Research, 108 Military Hospital, Hanoi, Vietnam
| | - Trinh Van Son
- Institute of Clinical Infectious Diseases, 108 Military Central Hospital, No 1, Tran Hung Dao Street, Hai Ba Trung Dist, Hanoi, Vietnam
| | - Dao Thanh Quyen
- Department of Molecular Biology, 108 Military Central Hospital, Hanoi, Vietnam
| | - Dang Thi Viet Anh
- Department of Molecular Biology, 108 Military Central Hospital, Hanoi, Vietnam
| | - Vu Viet Sang
- Institute of Clinical Infectious Diseases, 108 Military Central Hospital, No 1, Tran Hung Dao Street, Hai Ba Trung Dist, Hanoi, Vietnam
| | - Nguyen Xuan Lam
- Institute of Clinical Infectious Diseases, 108 Military Central Hospital, No 1, Tran Hung Dao Street, Hai Ba Trung Dist, Hanoi, Vietnam
| | - Nguyen Dang Manh
- Institute of Clinical Infectious Diseases, 108 Military Central Hospital, No 1, Tran Hung Dao Street, Hai Ba Trung Dist, Hanoi, Vietnam
| | - Vuong Phuc Duong
- Institute of Clinical Infectious Diseases, 108 Military Central Hospital, No 1, Tran Hung Dao Street, Hai Ba Trung Dist, Hanoi, Vietnam
| | - Bui Tri Cuong
- Institute of Clinical Infectious Diseases, 108 Military Central Hospital, No 1, Tran Hung Dao Street, Hai Ba Trung Dist, Hanoi, Vietnam
| | - Quyen Dang Tuyen
- Institute of Clinical Infectious Diseases, 108 Military Central Hospital, No 1, Tran Hung Dao Street, Hai Ba Trung Dist, Hanoi, Vietnam
| | - Nguyen Xuan Chinh
- Institute of Clinical Infectious Diseases, 108 Military Central Hospital, No 1, Tran Hung Dao Street, Hai Ba Trung Dist, Hanoi, Vietnam
| | - Phan Quoc Hoan
- Department of Molecular Biology, 108 Military Central Hospital, Hanoi, Vietnam
| | - Hoang Van Tong
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany.,Vietnamese-German Centre for Medical Research, 108 Military Hospital, Hanoi, Vietnam
| | - Christian G Meyer
- Vietnamese-German Centre for Medical Research, 108 Military Hospital, Hanoi, Vietnam
| | - Le Huu Song
- Department of Molecular Biology, 108 Military Central Hospital, Hanoi, Vietnam. .,Institute of Clinical Infectious Diseases, 108 Military Central Hospital, No 1, Tran Hung Dao Street, Hai Ba Trung Dist, Hanoi, Vietnam. .,Vietnamese-German Centre for Medical Research, 108 Military Hospital, Hanoi, Vietnam.
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Xiao X, Zhang Y, Zhang L, Kang P, Ji N. The diagnostic value of cerebrospinal fluid lactate for post-neurosurgical bacterial meningitis: a meta-analysis. BMC Infect Dis 2016; 16:483. [PMID: 27618955 PMCID: PMC5020553 DOI: 10.1186/s12879-016-1818-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 09/07/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Bacterial meningitis is not rare in post-neurosurgical patients. If patients are not treated promptly, the mortality rate can reach 20 to 50 %. The concentration of cerebrospinal fluid (CSF) lactate has been reported to be helpful in the diagnosis of bacterial meningitis; however, no systematic evaluations have investigated CSF from a postoperative perspective. In this study, we performed a systematic evaluation and meta-analysis of the efficacy of using CSF lactate concentrations in the diagnosis of post-neurosurgical bacterial meningitis. METHOD We retrieved studies that investigated the diagnostic value of CSF lactate for the diagnosis of post-neurosurgical bacterial meningitis by searching PubMed, EBSCO, the Cochrane Library and ClinicalTrials.gov. All these databases were searched from inception to November 2015. We used Quality Assessment of Diagnostic Accuracy Studies (QUADAS), a tool for the quality assessment of diagnostic accuracy, to evaluate the quality of the included studies. The Meta-DiSc 1.4 and Review Manager 5.3 software programs were used to analyze the included studies. Forest plots and summary receiver operating characteristics (SROC) curves were also drawn. RESULTS Five studies, involving a total of 404 post-neurosurgical patients, were selected from 1,672 articles according to the inclusion criteria. The quality of the five included studies was assessed using QUADAS, and the related results are presented in tables. The meta-analysis revealed the following diagnostic values regarding CSF lactate for post-neurosurgical bacterial meningitis: a pooled sensitivity of 0.92 (95 % CI 0.85-0.96), a pooled specificity of 0.88 (95 % CI 0.84-0.92 with significant heterogeneity), a diagnostic odds ratio of 83.09 (95 % CI 36.83-187.46), an area under the curve (AUCSROC) of 0.9601, an SE(AUC) of 0.0122, a Q* of 0.9046 and an SE(Q*) of 0.0179. CONCLUSION The meta-analysis indicated that the CSF lactate concentration has relatively high sensitivity and specificity for the diagnosis of post-neurosurgical bacterial meningitis and thus has relatively good efficacy.
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Affiliation(s)
- Xiong Xiao
- Department of Neurosurgery/China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, 6 Tian Tan Xi Li, Beijing, 100050, China
| | - Yang Zhang
- Department of Neurosurgery/China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, 6 Tian Tan Xi Li, Beijing, 100050, China
| | - Liwei Zhang
- Department of Neurosurgery/China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, 6 Tian Tan Xi Li, Beijing, 100050, China
| | - Peng Kang
- Department of Neurosurgery/China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, 6 Tian Tan Xi Li, Beijing, 100050, China
| | - Nan Ji
- Department of Neurosurgery/China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, 6 Tian Tan Xi Li, Beijing, 100050, China.
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Damestani Y, De Howitt N, Halaney DL, Garay JE, Aguilar G. Evaluation of laser bacterial anti-fouling of transparent nanocrystalline yttria-stabilized-zirconia cranial implant. Lasers Surg Med 2016; 48:782-789. [PMID: 27389389 DOI: 10.1002/lsm.22558] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2016] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND OBJECTIVE The development and feasibility of a novel nanocrystalline yttria-stabilized-zirconia (nc-YSZ) cranial implant has been recently established. The purpose of what we now call "window to the brain (WttB)" implant (or platform), is to improve patient care by providing a technique for delivery and/or collection of light into/from the brain, on demand, over large areas, and on a chronically recurring basis without the need for repeated craniotomies. WttB holds the transformative potential for enhancing light-based diagnosis and treatment of a wide variety of brain pathologies including cerebral edema, traumatic brain injury, stroke, glioma, and neurodegenerative diseases. However, bacterial adhesion to the cranial implant is the leading factor for biofilm formation (fouling), infection, and treatment failure. Escherichia coli (E. coli), in particular, is the most common isolate in gram-negative bacillary meningitis after cranial surgery or trauma. The transparency of our WttB implant may provide a unique opportunity for non-invasive treatment of bacterial infection under the implant using medical lasers. STUDY DESIGN/MATERIALS AND METHODS A drop of a diluted overnight culture of BL21-293 E. coli expressing luciferase was seeded between the nc-YSZ implant and the agar plate. This was followed by immediate irradiation with selected laser. After each laser treatment the nc-YSZ was removed, and cultures were incubated for 24 hours at 37 °C. The study examined continuous wave (CW) and pulsed wave (PW) modes of near-infrared (NIR) 810 nm laser wavelength with a power output ranging from 1 to 3 W. During irradiation, the temperature distribution of nc-YSZ surface was monitored using an infrared thermal camera. Relative luminescence unit (RLU) was used to evaluate the viability of bacteria after the NIR laser treatment. RESULTS Analysis of RLU suggests that the viability of E. coli biofilm formation was reduced with NIR laser treatment when compared to the control group (P < 0.01) and loss of viability depends on both laser fluence and operation mode (CW or PW). The results demonstrate that while CW laser reduces the biofilm formation more than PW laser with the same power, the higher surface temperature of the implant generated by CW laser limits its medical efficacy. In contrast, with the right parameters, PW laser produces a more moderate photothermal effect which can be equally effective at controlling bacterial growth. CONCLUSIONS Our results show that E. coli biofilm formation across the thickness of the nc-YSZ implant can be disrupted using NIR laser treatment. The results of this in vitro study suggest that using nc-YSZ as a cranial implant in vivo may also allow for locally selective, non-invasive, chronic treatment of bacterial layers (fouling) that might form under cranial implants, without causing adverse thermal damage to the underlying host tissue when appropriate laser parameters are used. Lasers Surg. Med. 48:782-789, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Yasaman Damestani
- Department of Bioengineering, University of California - Riverside, Riverside, California, 92521
| | - Natalie De Howitt
- Department of Bioengineering, University of California - Riverside, Riverside, California, 92521
| | - David L Halaney
- Department of Mechanical Engineering, University of California - Riverside, Riverside, California, 92521
| | - Javier E Garay
- Department of Mechanical and Aerospace Engineering, University of California - San Diego, La Jolla, California, 92093
| | - Guillermo Aguilar
- Department of Bioengineering, University of California - Riverside, Riverside, California, 92521. .,Department of Mechanical Engineering, University of California - Riverside, Riverside, California, 92521.
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27
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Wang L, Zhang J, Yu X, Wang J, Cheng L, Hu S, Han G. Intrathecal injection of tigecycline in treatment of multidrug-resistant Acinetobacter baumannii meningitis: a case report. Eur J Hosp Pharm 2016; 24:182-184. [PMID: 31156934 DOI: 10.1136/ejhpharm-2016-000972] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 06/06/2016] [Accepted: 06/10/2016] [Indexed: 11/03/2022] Open
Abstract
The ubiquitous Acinetobacter baumannii is an important and troublesome pathogen of nosocomial infection. Multidrug-resistant A baumannii meningitis is very difficult to treat, usually with high mortality. The disease is generally associated with craniotomy, but rarely with lumbar puncture. However, in our case, a 45-year-old male construction worker suffered multidrug-resistant A baumannii meningitis associated with lumbar puncture. The patient responded poorly to the initial treatment with an intravenous infusion of tigecycline. However, later treatment with an intrathecal injection of tigecycline (concentration 1 mg/mL) at a dose of 10 mg every 12 hours proved to be highly efficacious. Thus, intrathecal injection of tigecycline should be seriously considered as a treatment for multidrug-resistant A baumannii meningitis.
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Affiliation(s)
- Lijiang Wang
- Department of Neurosurgery, Shengli Oilfield Central Hospital of Binzhou Medical University, Dongying, Shandong, China
| | - Jirong Zhang
- Department of Neurosurgery, Shengli Oilfield Central Hospital of Binzhou Medical University, Dongying, Shandong, China
| | - Xiaoqing Yu
- Department of Neurosurgery, Shengli Oilfield Central Hospital of Binzhou Medical University, Dongying, Shandong, China
| | - Jiuzhong Wang
- Department of Neurosurgery, Shengli Oilfield Central Hospital of Binzhou Medical University, Dongying, Shandong, China
| | - Lifeng Cheng
- Department of Neurosurgery, Shengli Oilfield Central Hospital of Binzhou Medical University, Dongying, Shandong, China
| | - Shuzhen Hu
- Department of Neurosurgery, Shengli Oilfield Central Hospital of Binzhou Medical University, Dongying, Shandong, China
| | - Guangliang Han
- Department of Neurosurgery, Shengli Oilfield Central Hospital of Binzhou Medical University, Dongying, Shandong, China
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The Efficacy of Antibacterial Prophylaxis Against the Development of Meningitis After Craniotomy: A Meta-Analysis. World Neurosurg 2016; 90:597-603.e1. [DOI: 10.1016/j.wneu.2016.02.048] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 02/07/2016] [Accepted: 02/09/2016] [Indexed: 11/18/2022]
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Pourhajibagher M, Hashemi FB, Pourakbari B, Aziemzadeh M, Bahador A. Antimicrobial Resistance of Acinetobacter baumannii to Imipenem in Iran: A Systematic Review and Meta-Analysis. Open Microbiol J 2016; 10:32-42. [PMID: 27099638 PMCID: PMC4814728 DOI: 10.2174/1874285801610010032] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 11/10/2015] [Accepted: 11/13/2015] [Indexed: 11/22/2022] Open
Abstract
Imipenem-resistant multi-drug resistant (IR-MDR) Acinetobacter baumannii
has been emerged as a morbidity successful nosocomial pathogen throughout the
world.To address imipenem being yet the most effective antimicrobial
agent against A. baumannii to control outbreaks and treat patients, a
systematic review and meta-analysis was performed to evaluate the prevalence of
IR-MDR A. baumannii. We systematically searched Web of Science, PubMed,
MEDLINE, Science Direct, EMBASE, Scopus, Cochrane Library, Google Scholar, and
Iranian databases to identify studies addressing the antibiotic resistance of
A. baumannii to imipenem and the frequency of MDR strains in Iran. Out of 58
articles and after a secondary screening using inclusion and exclusion criteria
and on the basis of title and abstract evaluation, 51 studies were selected for
analysis. The meta-analysis revealed that 55% [95% confidence interval (CI),
53.0–56.5] of A. baumannii were resistant to imipenem and 74% (95% CI,
61.3–83.9) were MDR. The MDR A. baumannii population in Iran is rapidly
changing toward a growing resistance to imipenem. Our findings highlight the
critical need for a comprehensive monitoring and infection control policy as
well as a national susceptibility review program that evaluates IR-MDR A.
baumannii isolates from various parts of Iran.
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Affiliation(s)
- Maryam Pourhajibagher
- Department of Microbiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Farhad B Hashemi
- Department of Microbiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Babak Pourakbari
- Pediatrics Infectious Disease Research Center, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoud Aziemzadeh
- Department of Microbiology, School of Medicine, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Abbas Bahador
- Department of Microbiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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30
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Postoperative Central Nervous System Infection After Neurosurgery in a Modernized, Resource-Limited Tertiary Neurosurgical Center in South Asia. World Neurosurg 2015; 84:1668-73. [DOI: 10.1016/j.wneu.2015.07.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 07/04/2015] [Accepted: 07/04/2015] [Indexed: 11/21/2022]
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Management of Meningitis Caused by Multi Drug-Resistant Acinetobacter Baumannii: Clinical, Microbiological and Pharmacokinetic Results in a Patient Treated with Colistin Methanesulfonate. Mediterr J Hematol Infect Dis 2015; 7:e2015055. [PMID: 26543524 PMCID: PMC4621166 DOI: 10.4084/mjhid.2015.055] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 09/04/2015] [Indexed: 11/08/2022] Open
Abstract
This paper reports on a 71- year-old Caucasian male who underwent neurosurgery for an oligodendroglioma, followed by a cranial-sinus fistula and cerebrospinal fluid rhinorrhea. The clinical course was complicated due to an extensively drug-resistant Acinetobacter baumannii meningitis. The patient was treated with colistin methanesulfonate, intrathecal for 24 days and intravenous for 46 days. In addition, the patient received meropenem and teicoplanin to treat a urinary tract infection and a bacterial aspiration pneumonia. Cerebrospinal fluid trough colistin levels resulted above the MIC of A. baumannii. Colistin cerebrospinal fluid concentration did not increase over the treatment period. Meningitis was cured and A. baumannii eradicated. No side effects from the antimicrobial therapy were observed. In conclusion, this case highlights the issues in treating infections caused by resistant Gram negative bacteria and supports previous findings on the efficacy, pharmacokinetic and tolerability of intravenous and intrathecal colistin treatments.
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Tian R, Hao S, Hou Z, Gao Z, Liu B. The characteristics of post-neurosurgical bacterial meningitis in elective neurosurgery in 2012: A single institute study. Clin Neurol Neurosurg 2015; 139:41-5. [PMID: 26364156 DOI: 10.1016/j.clineuro.2015.09.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 08/10/2015] [Accepted: 09/02/2015] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Most post-neurosurgical meningitis research has been focused on large cohorts with numerous cases followed over several years. However, the characteristics of post-neurosurgical meningitis in an entire single year are still unclear, and knowledge of these characteristics might influence the selection of appropriate antibiotics and therapeutic strategies for the successful management of this disease. Our aim is to obtain a better understanding of post-neurosurgical meningitis over a single entire year. MATERIALS AND METHODS Patients with positive meningitis cultures after neurosurgical operations in our hospital during the entire year of 2012 were included in the analysis. We report demographic characteristics, morbidity during different seasons, clinical and bacteriological profiles, sensitivity to antibiotics and causes of the post-neurosurgical meningitis infections in our cohort. RESULTS Of the 6407 patients who underwent neurosurgical procedures during the study period, 146 developed post-neurosurgical meningitis and the overall incidence of meningitis was 2.28%. The incidence of meningitis was significantly higher in patients who underwent surgery in the autumn and winter than spring or summer (p=0.000). The most common organisms causing meningitis were Gram-positive bacteria, followed by the Klebsiella and Baumannii species. Compound sulfamethoxazole (52.6%) and vancomycin (10.5%) were the most active antibiotics against Gram-positive bacteria strains, whereas meropenem (43.8%) and polymyxin (18.8%) were active against Gram-negative bacillus strains. CONCLUSIONS Post-neurosurgical meningitis usually occurs in the autumn and winter of the year in our hospital. Gram-positive organisms, which are sensitive to compound sulfamethoxazole and vancomycin, are the most common causative pathogens of post-neurosurgical meningitis in the northern mainland of China.
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Affiliation(s)
- Runfa Tian
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Beijing Key Laboratory of Central Nervous System Injury, Beijing, China
| | - Shuyu Hao
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Beijing Key Laboratory of Central Nervous System Injury, Beijing, China
| | - Zonggang Hou
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Beijing Key Laboratory of Central Nervous System Injury, Beijing, China
| | - Zhixian Gao
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Beijing Key Laboratory of Central Nervous System Injury, Beijing, China
| | - Baiyun Liu
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China; Nerve Injury and Repair Center of Beijing Institute for Brain Disorders, Beijing, China; Neurotrauma Laboratory, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China; Department of Neurotrauma, General Hospital of Armed Police Forces, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Beijing Key Laboratory of Central Nervous System Injury, Beijing, China.
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Nau R, Djukic M, Spreer A, Ribes S, Eiffert H. Bacterial meningitis: an update of new treatment options. Expert Rev Anti Infect Ther 2015; 13:1401-23. [DOI: 10.1586/14787210.2015.1077700] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Bardak-Ozcem S, Sipahi OR. An updated approach to healthcare-associated meningitis. Expert Rev Anti Infect Ther 2014; 12:333-42. [PMID: 24512210 DOI: 10.1586/14787210.2014.890049] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Among hospital-associated infections, healthcare-associated central nervous system infections are quite important because of high morbidity and mortality rates. The causative agents of healthcare-associated meningitis differ according to the status of immune systems and underlying diseases. The most frequent agents are Gram-negative bacilli (Pseudomonas spp., Acinetobacter spp., Escherichia coli and Klebsiella pneumoniae) and Gram-positive cocci (Staphylococcus aureus and coagulase-negative staphylococci). There are currently several problems in the treatment strategies of healthcare-associated meningitis due to a globally increasing resistance problem. Strategies targeting multidrug-resistant pathogens are especially limited. This review focuses on healthcare-associated meningitis and the current treatment strategies with a particular focus on methicillin-resistant Staphylococcus aureus (MRSA) meningitis.
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Affiliation(s)
- Selin Bardak-Ozcem
- Infectious Diseases and Clinical Microbiology Clinic, Dr. Burhan Nalbantoglu State Hospital, Nicosia, Turkish Republic of Northern Cyprus
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Predictive value of decoy receptor 3 in postoperative nosocomial bacterial meningitis. Int J Mol Sci 2014; 15:19962-70. [PMID: 25372942 PMCID: PMC4264149 DOI: 10.3390/ijms151119962] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 09/28/2014] [Accepted: 10/22/2014] [Indexed: 11/28/2022] Open
Abstract
Nosocomial bacterial meningitis requires timely treatment, but what is difficult is the prompt and accurate diagnosis of this disease. The aim of this study was to assess the potential role of decoy receptor 3 (DcR3) levels in the differentiation of bacterial meningitis from non-bacterial meningitis. A total of 123 patients were recruited in this study, among them 80 patients being with bacterial meningitis and 43 patients with non-bacterial meningitis. Bacterial meningitis was confirmed by bacterial culture of cerebrospinal fluid (CSF) culture and enzyme-linked immunosorbent assay (ELISA) was used to detect the level of DcR3 in CSF. CSF levels of DcR3 were statistically significant between patients with bacterial meningitis and those with non-bacterial meningitis (p < 0.001). A total of 48.75% of patients with bacterial meningitis received antibiotic >24 h before CSF sampling, which was much higher than that of non-bacterial meningitis. CSF leucocyte count yielded the highest diagnostic value, with an area under the receiver operating characteristic curve (ROC) of 0.928, followed by DcR3. At a critical value of 0.201 ng/mL for DcR3, the sensitivity and specificity were 78.75% and 81.40% respectively. DcR3 in CSF may be a valuable predictor for differentiating patients with bacterial meningitis from those with non-bacterial meningitis. Further studies are needed for the validation of this study.
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Wang JH, Lin PC, Chou CH, Ho CM, Lin KH, Tsai CT, Wang JH, Chi CY, Ho MW. Intraventricular antimicrobial therapy in postneurosurgical Gram-negative bacillary meningitis or ventriculitis: A hospital-based retrospective study. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2014. [DOI: 10.1016/j.jmii.2012.08.028] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Zhou H, Zhang X. Intracranial malignant lesions correlate with the requirement for a long treatment course in postoperative central nervous system infection. Neuropsychiatr Dis Treat 2014; 10:2071-7. [PMID: 25395855 PMCID: PMC4226452 DOI: 10.2147/ndt.s71836] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
AIM Our aim was to study the clinical features of postoperative meningitis after neurosurgery and identify the factors affecting the duration of treatment. METHODS This retrospective study assessed 283 patients with postoperative bacterial meningitis in the Neurosurgery Department of Beijing Tiantan Hospital, Beijing, People's Republic of China, between January and December 2012. Patients' clinical data were reviewed, and multivariate logistic regression analysis was used to identify the factors associated with a prolonged treatment course. RESULTS The mortality rate was 0.4% in these patients, of whom 12.4% were found with pathogens in the cerebrospinal fluid. Among the three most common pathogens detected were methicillin-resistant Staphylococcus aureus, Acinetobacter baumannii, and Pseudomonas aeruginosa. The mean treatment course was 13.5±2.1 days. Interestingly, the treatment duration for postoperative meningitis was significantly longer in patients with intracranial malignant tumors than in those with benign lesions. Single-factor analysis showed that male sex (P=0.042) and malignant (rather than benign) lesions (P<0.001) were significantly associated with prolonged treatment duration. Multivariate analysis further confirmed that malignant intracranial lesions represented an independent risk factor for prolonged treatment duration (odds ratio: 2.5962; 95% confidence interval: 1.1092-6.6134). CONCLUSION The nature of the intracranial lesion is an independent risk factor for the duration of treatment in postoperative meningitis after neurosurgery.
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Affiliation(s)
- Heng Zhou
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Xinghu Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
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Moorthy RK, Sarkar H, Rajshekhar V. Conservative antibiotic policy in patients undergoing non-trauma cranial surgery does not result in higher rates of postoperative meningitis: An audit of nine years of narrow-spectrum prophylaxis. Br J Neurosurg 2013; 27:497-502. [DOI: 10.3109/02688697.2013.771138] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Chang CJ, Chang BL, Tsai KC, Lai YJ, Fan CM. Acinetobacter baumannii post-operative meningitis. Surg Infect (Larchmt) 2012; 13:338-9. [PMID: 23039236 DOI: 10.1089/sur.2012.083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Grille P, Torres J, Porcires F, Bagnulo H. Value of cerebrospinal fluid lactate for the diagnosis of bacterial meningitis in postoperative neurosurgical patients. Neurocirugia (Astur) 2012; 23:131-5. [PMID: 22704649 DOI: 10.1016/j.neucir.2011.11.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Accepted: 11/19/2011] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the diagnostic value of CSF lactate (L(CSF)) for the diagnosis of bacterial meningitis (BM) following neurosurgery, and compare it with other CSF markers. METHODS Prospective study of consecutive neurosurgical postoperative patients admitted to the Intensive Care Unit (ICU) at Maciel Hospital. Patients with clinical suspicion of BM were categorised, according to preset criteria, into 3 groups: (1) proven BM; (2) probable BM, and (3) excluded BM. CSF markers were plotted in a receiver operating curve (ROC) to evaluate their diagnostic accuracy. RESULTS The study included 158 patients. We obtained 46 CSF samples from patients with clinical suspicion of BM by lumbar puncture (LP): 10 corresponded to proven BM, 4 to probable BM and 32 to excluded BM. Mean lactate in CSF (L(CSF)) was: 10.72±4.68mM for proven BM, 6.07±0.66mM for probable BM and 3.06±1.11mM for excluded BM (P<.001 for proven BM and probable BM vs excluded BM; P=NS for proven BM vs probable BM). L(CSF) displayed a better diagnostic accuracy for BM in the 2 scenarios studied: (1) positive bacterial CSF culture or Gram stain as positive control (gold standard) (sensitivity: 87%, specificity: 94%, cut-off value: 5.9mM), and (2) combination of proven BM and probable BM as positive control (sensitivity: 92%, specificity: 100%, cut-off value: 5.2mM). CONCLUSIONS According to our results, determination of L(CSF) is a quick, sensitive and specific test to identify the need for antimicrobial therapy in neurosurgical postoperative patients with clinical suspicion of BM.
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Affiliation(s)
- Pedro Grille
- Intensive Care Unit, Maciel Hospital, Montevideo, Uruguay
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Kim HI, Kim SW, Park GY, Kwon EG, Kim HH, Jeong JY, Chang HH, Lee JM, Kim NS. The causes and treatment outcomes of 91 patients with adult nosocomial meningitis. Korean J Intern Med 2012; 27:171-9. [PMID: 22707889 PMCID: PMC3372801 DOI: 10.3904/kjim.2012.27.2.171] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Revised: 10/10/2011] [Accepted: 12/13/2011] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS 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.
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Affiliation(s)
- Hye-In Kim
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Shin-Woo Kim
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Ga-Young Park
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Eu-Gene Kwon
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Hyo-Hoon Kim
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Ju-Young Jeong
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Hyun-Ha Chang
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Jong-Myung Lee
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Neung-Su Kim
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
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Clinical features and outcome of community-acquired bacterial meningitis in adult patients with liver cirrhosis. Am J Med Sci 2011; 340:452-6. [PMID: 20811273 DOI: 10.1097/maj.0b013e3181ee988d] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION This study aimed to analyze the clinical features, causative pathogens and therapeutic outcomes of bacterial meningitis in patients with liver cirrhosis. METHODS Adult cirrhotic patients with community-acquired bacterial meningitis were evaluated. Clinical data were collected over a 22-year period. For comparison, the clinical features and therapeutic outcomes between patients with and without liver cirrhosis were analyzed. RESULTS Liver cirrhosis accounted for 11% (25/217) of the predisposing factors. Significant statistical analysis between the 2 groups (patients with and without liver cirrhosis) included median Glasgow Coma Scale score at presentation, presence of seizure, bacteremia and septic shock. The mean duration between arrival at the emergency room and confirmed diagnosis of bacterial meningitis was 39 hours (range, 2-240 hours). Ten (10/25, 40%) were initially diagnosed with bacterial meningitis, and 6 (6/25, 24%) were initially suggested as having infection of unknown origin. In this study, Klebsiella pneumoniae was the most frequent causative pathogen in patients with liver cirrhosis. The overall case fatality rates for patients with and without liver cirrhosis were 38.5% (74/192) and 64% (16/25), respectively. CONCLUSIONS Patients with liver cirrhosis have a more fulminant course with a higher prevalence of disturbed consciousness, bacteremia, seizure and shock. Diagnosis and effective treatment ARE often delayed, resulting in high overall mortality. When patients with liver cirrhosis develop disturbed consciousness, seizures and septicemia, immediate neuroimaging and cerebrospinal fluid studies should be undertaken to determine bacterial meningitis. Early diagnosis and treatment are essential for survival.
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Tigecycline use in two cases with multidrug-resistant Acinetobacter baumannii meningitis. Int J Infect Dis 2010; 14 Suppl 3:e224-6. [DOI: 10.1016/j.ijid.2009.07.022] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2009] [Revised: 06/19/2009] [Accepted: 07/30/2009] [Indexed: 11/21/2022] Open
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Kourbeti IS, Papadakis JA, Neophytou C, Filippou M, Ioannou A, Karabetsos DA, Bertsias G, Anastasaki M, Vakis AF. Infections in patients with traumatic brain injury who undergo neurosurgery. Br J Neurosurg 2010; 25:9-15. [DOI: 10.3109/02688697.2010.500411] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Khawcharoenporn T, Apisarnthanarak A, Mundy L. Intrathecal colistin for drug-resistant Acinetobacter baumannii central nervous system infection: a case series and systematic review. Clin Microbiol Infect 2010; 16:888-94. [DOI: 10.1111/j.1469-0691.2009.03019.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Chang WN, Lu CH, Huang CR, Chuang YC, Tsai NW, Chang CC, Chen SF, Wang HC, Yang TM, Hsieh MJ, Chien CC. Clinical characteristics of post-neurosurgical Klebsiella pneumoniae meningitis in adults and a clinical comparison to the spontaneous form in a Taiwanese population. J Clin Neurosci 2010; 17:334-8. [DOI: 10.1016/j.jocn.2009.06.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2009] [Revised: 06/10/2009] [Accepted: 06/15/2009] [Indexed: 10/19/2022]
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Aguilar J, Urday-Cornejo V, Donabedian S, Perri M, Tibbetts R, Zervos M. Staphylococcus aureus meningitis: case series and literature review. Medicine (Baltimore) 2010; 89:117-125. [PMID: 20517182 DOI: 10.1097/md.0b013e3181d5453d] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Staphylococcus aureus meningitis is a challenging disease and little is known about its epidemiology. There are no established management guidelines. We retrospectively reviewed the clinical information, bacteriologic data, and outcomes of all 33 patients with cerebrospinal fluid (CSF) cultures positive for S aureus seen at a single urban teaching hospital from 1999 to 2008. Pulsed-field gel electrophoresis (PFGE) and polymerase chain reaction for staphylococcal cassette chromosome mec (SCCmec), accessory gene regulator (agr) typing, and Panton-Valentine leukocidin (PVL) loci were done on methicillin-resistant S aureus (MRSA) CSF isolates starting in 2005. S aureus caused 12 (36%) cases of postoperative and 21 (64%) cases of hematogenous meningitis. MRSA isolates were found in 6 (50%) cases of postoperative and 10 (48%) cases of hematogenous meningitis. Twelve (75%) of the 16 MRSA infections occurred in the last 5 years of the study. Hematogenous meningitis was associated with older age (p = 0.04), injection drug use (p < 0.01), community-acquired infection (p < 0.01), underlying disease (p = 0.01), staphylococcal infection outside the central nervous system (p = 0.01), altered mental status (p = 0.02), fever (p = 0.01), septic shock (p = 0.03), and bacteremia (p < 0.01). The analysis of the 9 MRSA isolates showed 3 PFGE types: 3 USA100 (33%), 5 USA300 (56%), and 1 USAnot100-1100 (11%). For SCCmec typing, there were 2 (22%) type II and 7 (78%) type IV. All USA300 strains were SCCmec IVa. For agr typing, there were 5 (56%) type I and 4 (44%) type II. Three isolates (33%) were positive for the PVL gene and were USA300 strains. Most patients received nafcillin or vancomycin with or without rifampin or trimethoprim/sulfamethoxazole for a mean period of 17 days (range, 1-42 d). Overall mortality was 36%, and it was associated with community-acquired infection (p = 0.02). Postoperative and hematogenous S aureus meningitis are distinct clinical syndromes. S aureus hematogenous meningitis has devastating clinical consequences and elevated mortality rates, especially if it is acquired in the community. The incidence of MRSA meningitis increased over the last 5 years of the study. Treatment of choice is nafcillin for methicillin-sensitive strains and vancomycin for MRSA strains. The addition of trimethoprim/sulfamethoxazole or rifampin to vancomycin is recommended in severe cases and community-acquired MRSA infections. Linezolid is also a good option due to its good CSF penetration and favorable case reports. The mortality rate is higher in infections acquired in the community.
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Affiliation(s)
- Javier Aguilar
- From Division of Infectious Diseases and Microbiology (JA, VUC, SD, MP,RT, MZ), Henry Ford Hospital, Detroit, Michigan; and Wayne State University School of Medicine (MZ), Detroit, Michigan
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Krol V, Hamid N, Cunha B. Neurosurgically related nosocomial Acinetobacter baumannii meningitis: report of two cases and literature review. J Hosp Infect 2009; 71:176-80. [DOI: 10.1016/j.jhin.2008.09.018] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2007] [Accepted: 09/26/2008] [Indexed: 11/30/2022]
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Hong YA, Yoo JH, Kim JJ, Mo EY, Ahn GH, Jeong HK, Kim JS, Lee HJ, Jung MH, Yoon SB. A Case of Multidrug-resistant Acinetobacter baumannii Ventriculitis Successfully Treated with Intrathecal Colistimethate. Infect Chemother 2009. [DOI: 10.3947/ic.2009.41.4.240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Yu-ah Hong
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jin-Hong Yoo
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jin-Jin Kim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Eun-Yeong Mo
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Gun-Hee Ahn
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hee-Kyoung Jeong
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jin-Seok Kim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyun-Jeong Lee
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Mi-Hyang Jung
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seung-Bae Yoon
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Abstract
Despite advances in medical care including antibiotics and vaccines, meningitis still has a high morbidity and mortality rate, especially in certain high-risk patients. Early diagnosis with the administration of appropriate antibiotics remains the key element of management. This article highlights methods of diagnosis, differential diagnoses, treatment options, and complications of treating bacterial meningitis.
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Affiliation(s)
- Sharon E Mace
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, E19, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
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