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Căpățînă D, Feier B, Hosu O, Tertiș M, Cristea C. Analytical methods for the characterization and diagnosis of infection with Pseudomonas aeruginosa: A critical review. Anal Chim Acta 2022; 1204:339696. [DOI: 10.1016/j.aca.2022.339696] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 02/05/2022] [Accepted: 03/06/2022] [Indexed: 12/11/2022]
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Finger G, Worm PV, Dos Santos SC, do Nascimento TL, Gallo P, Stefani MA. Cerebrospinal Fluid Collected by Lumbar Puncture Has a Higher Diagnostic Accuracy than Collected by Ventriculostomy. World Neurosurg 2020; 138:e683-e689. [PMID: 32194271 DOI: 10.1016/j.wneu.2020.03.045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 03/05/2020] [Accepted: 03/06/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Patients harboring an external ventricular drain (EVD) who develop signs of infection require screening for infection in the central nervous system (CNS). The cerebrospinal fluid (CSF) can be collected by the EVD or by lumbar puncture (LP). If only one sample is analyzed, the diagnosis might be dubious or false-negative. The objective of this study was to compare the diagnosis accuracy of CNS infection of CSF samples collected from EVD and LP. METHODS We conducted a transversal study where data were prospectively collected from 2016 to 2019. Patients harboring EVD with signs of infection were submitted to the CSF analysis collected by LP and EVD. Diagnosis sensibility and results correlation were analyzed using the kappa index. RESULTS The 141 samples from LP and 141 samples from EVD were collected from 108 patients. Among the 282 samples, a total of 77 had infection. Seventy CSF samples from LP fulfilled infection criteria. However, only 32 EVD samples demonstrated infection. Among the 70 cases of infection based on the LP sample, 25 CSF samples collected from the EVD were also suggestive of infection; but in 45 patients only the CSF samples from LP met infection criteria. Seven patients had diagnosis of infection only in the EVD sample. The kappa correlation index of the results obtained from LP and EVD was 0.260 and the McNemar χ2 test was <0.01. CONCLUSIONS The CSF analysis exclusive from the EVD has a low sensibility and negative predictive value. CSF collected from LP has a sensibility 2.18 times higher than EVD.
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Affiliation(s)
- Guilherme Finger
- Neurosurgery Department, Cristo Redentor Hospital, Porto Alegre RS, Brazil; Graduate Program in Medicine: Surgical Sciences, Federal University of Rio Grande do Sul, Porto Alegre RS, Brazil.
| | - Paulo Valdeci Worm
- Neurosurgery Department, Cristo Redentor Hospital, Porto Alegre RS, Brazil
| | | | - Tobias Ludwig do Nascimento
- Neurosurgery Department, Cristo Redentor Hospital, Porto Alegre RS, Brazil; Graduate Program in Medicine: Surgical Sciences, Federal University of Rio Grande do Sul, Porto Alegre RS, Brazil
| | - Pasquale Gallo
- Neurosurgery Department, Cristo Redentor Hospital, Porto Alegre RS, Brazil
| | - Marco Antônio Stefani
- Graduate Program in Medicine: Surgical Sciences, Federal University of Rio Grande do Sul, Porto Alegre RS, Brazil
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Evaluation of the Formation of Single- and Double-Species Biofilms on Intraventricular Catheters by Strains of Staphylococcus aureus, Listeria monocytogenes and Escherichia coli with K1 Antigen. Jundishapur J Microbiol 2018. [DOI: 10.5812/jjm.62323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Efficacy of Closed Continuous Lumbar Drainage on the Treatment of Postcraniotomy Meningitis: A Retrospective Analysis of 1062 Cases. World Neurosurg 2017; 106:925-931. [DOI: 10.1016/j.wneu.2017.07.073] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Revised: 07/12/2017] [Accepted: 07/13/2017] [Indexed: 11/20/2022]
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Abstract
Klebsiella pneumoniae causes a wide range of infections, including pneumonias, urinary tract infections, bacteremias, and liver abscesses. Historically, K. pneumoniae has caused serious infection primarily in immunocompromised individuals, but the recent emergence and spread of hypervirulent strains have broadened the number of people susceptible to infections to include those who are healthy and immunosufficient. Furthermore, K. pneumoniae strains have become increasingly resistant to antibiotics, rendering infection by these strains very challenging to treat. The emergence of hypervirulent and antibiotic-resistant strains has driven a number of recent studies. Work has described the worldwide spread of one drug-resistant strain and a host defense axis, interleukin-17 (IL-17), that is important for controlling infection. Four factors, capsule, lipopolysaccharide, fimbriae, and siderophores, have been well studied and are important for virulence in at least one infection model. Several other factors have been less well characterized but are also important in at least one infection model. However, there is a significant amount of heterogeneity in K. pneumoniae strains, and not every factor plays the same critical role in all virulent Klebsiella strains. Recent studies have identified additional K. pneumoniae virulence factors and led to more insights about factors important for the growth of this pathogen at a variety of tissue sites. Many of these genes encode proteins that function in metabolism and the regulation of transcription. However, much work is left to be done in characterizing these newly discovered factors, understanding how infections differ between healthy and immunocompromised patients, and identifying attractive bacterial or host targets for treating these infections.
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Neuberger A, Shofty B, Bishop B, Naffaa M, Binawi T, Babich T, Rappaport Z, Zaaroor M, Sviri G, Yahav D, Paul M. Risk factors associated with death or neurological deterioration among patients with Gram-negative postneurosurgical meningitis. Clin Microbiol Infect 2016; 22:573.e1-4. [DOI: 10.1016/j.cmi.2016.03.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 03/21/2016] [Accepted: 03/22/2016] [Indexed: 10/22/2022]
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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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De Bonis P, Lofrese G, Scoppettuolo G, Spanu T, Cultrera R, Labonia M, Cavallo MA, Mangiola A, Anile C, Pompucci A. Intraventricular versus intravenous colistin for the treatment of extensively drug resistant Acinetobacter baumannii meningitis. Eur J Neurol 2015; 23:68-75. [PMID: 26228051 DOI: 10.1111/ene.12789] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 06/05/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Reports on the safety and efficacy of intraventricularly administered (IVT) colistin for the treatment of Acinetobacter baumannii ventriculomeningitis in adults are limited and no comparative studies of IVT colistin versus intravenous (IV) therapy alone have been published. This study compared outcomes of patients with postneurosurgical ventriculomeningitis caused by extensively drug-resistant A. baumannii treated with IV colistin or IV plus IVT colistin. METHODS In an 11-year period, information on 18 consecutive patients with extensively drug-resistant A. baumannii ventriculomeningitis was collected. Infection was defined on the basis of (i) isolation of A. baumannii from the cerebrospinal fluid (CSF); (ii) laboratory evidence of CSF infection; (iii) signs/symptoms of central nervous system (CNS) infection. Patients were divided into group 1 (nine patients, IV colistin alone) and group 2 (nine patients, IV plus IVT colistin). RESULTS Cerebrospinal fluid sterilization was documented for 12 of 18 patients (66.6%). The CSF sterilization rate was 33.3% in group 1 and 100% in group 2 (P = 0.009). The mean time to CSF sterilization was 21 days (range 8-48). Five patients died due to A. baumannii CNS infection (all in group 1), and five deaths were unrelated to A. baumannii ventriculomeningitis. Intensive care unit mean length of stay was shorter in group 2 (20.7 vs. 41.6 days, P = 0.046). Crude relative risk ratio of cumulative incidence of persistent CNS infection in group 1 versus group 2 was 13. No cases of chemical meningitis due to intrathecal colistin administration were encountered. CONCLUSIONS Intraventricular colistin administration is much more effective than IV therapy alone and does not seem to add further toxicity.
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Affiliation(s)
- P De Bonis
- Neurosurgery, Catholic University School of Medicine, Rome, Italy.,Neurosurgery, University Hospital S. Anna, Ferrara, Italy
| | - G Lofrese
- Neurosurgery, Catholic University School of Medicine, Rome, Italy
| | - G Scoppettuolo
- Infectious Diseases, Catholic University School of Medicine, Rome, Italy
| | - T Spanu
- Microbiology, Catholic University School of Medicine, Rome, Italy
| | - R Cultrera
- Infectious Diseases, University Hospital S. Anna, Ferrara, Italy
| | - M Labonia
- Department of Laboratory Medicine and Transfusion Medicine, Hospital for Research and Care Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - M A Cavallo
- Neurosurgery, University Hospital S. Anna, Ferrara, Italy
| | - A Mangiola
- Neurosurgery, Catholic University School of Medicine, Rome, Italy
| | - C Anile
- Neurosurgery, Catholic University School of Medicine, Rome, Italy
| | - A Pompucci
- Neurosurgery, Catholic University School of Medicine, Rome, Italy
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Su TM, Lan CM, Lee TH, Hsu SW. Gas-containing brain abscess: etiology, clinical characteristics, and outcome. Kaohsiung J Med Sci 2014; 30:619-24. [PMID: 25476100 DOI: 10.1016/j.kjms.2014.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 09/21/2014] [Accepted: 10/08/2014] [Indexed: 11/26/2022] Open
Abstract
Gas-containing brain abscess remains a life-threatening disease that requires immediate diagnostic and therapeutic intervention. The aim of this study is to report on a series of gas-containing brain abscess and discuss its pathological mechanism and therapeutic consideration. This study included 11 patients with gas-containing brain abscess at Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan during a 27-year period. The predisposing factors to infection included hematogenous spread in five patients, contiguous infection in one patient, and abnormal fistulous communication due to head injury in four patients. In one patient, the predisposing factor might be contiguous infection from frontal sinusitis or abnormal fistulous communication due to previous sinus surgery. Klebsiella pneumoniae was the most common causative pathogen that was isolated from the gas-containing abscess not related to skull base defect. Among these 11 patients, six underwent excision and five accepted aspiration for the surgical treatment of abscess. In the five patients who underwent aspiration, two required repeated craniotomy to excise the recurrent abscess and repair the abnormal fistulous communication through the skull base. When encountered with a gas-containing abscess in patients with an impaired host defense mechanism, K. pneumoniae infection should be suspected, and further attention should be paid to discovering if other metastatic septic abscesses exist. For patients with a history of basilar skull fracture or surgery involving the skull base, craniotomy is indicated to excise the abscess and repair the potential fistulous communication through the cranium. Aspiration may be a reasonable alternative to treat deep-seated lesions, lesions in an eloquent area, patients with severe concomitant medical disease, or patients without a history of basilar skull fracture or surgery involving the skull base. Prompt diagnosis, appropriate antibiotic use, and meticulous surgical treatment are the only way to obtain a favorable outcome.
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Affiliation(s)
- Tsung-Ming Su
- Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
| | - Chu-Mei Lan
- Department of Health Psychology, Chang Jung Christian University, Tainan, Taiwan
| | - Tsung-Han Lee
- Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Shih-Wei Hsu
- Department of Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Kourbeti IS, Vakis AF, Ziakas P, Karabetsos D, Potolidis E, Christou S, Samonis G. Infections in patients undergoing craniotomy: risk factors associated with post-craniotomy meningitis. J Neurosurg 2014; 122:1113-9. [PMID: 25343179 DOI: 10.3171/2014.8.jns132557] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECT The authors performed a prospective study to define the prevalence and microbiological characteristics of infections in patients undergoing craniotomy and to clarify the risk factors for post-craniotomy meningitis. METHODS Patients older than 18 years who underwent nonstereotactic craniotomies between January 2006 and December 2008 were included. Demographic, clinical, laboratory, and microbiological data were systemically recorded. Patient characteristics, craniotomy type, and pre- and postoperative variables were evaluated as risk factors for meningitis RESULTS Three hundred thirty-four procedures were analyzed (65.6% involving male patients). Traumatic brain injury was the most common reason for craniotomy. Almost 40% of the patients developed at least 1 infection. Ventilator-associated pneumonia (VAP) was the most common infection recorded (22.5%) and Acinetobacter spp. were isolated in 44% of the cases. Meningitis was encountered in 16 procedures (4.8%), and CSF cultures were positive for microbial growth in 100% of these cases. Gram-negative pathogens (Acinetobacter spp., Klebsiella spp., Pseudomonas aeruginosa, Enterobacter cloaceae, Proteus mirabilis) represented 88% of the pathogens. Acinetobacter and Klebsiella spp. demonstrated a high percentage of resistance in several antibiotic classes. In multivariate analysis, the risk for meningitis was independently associated with perioperative steroid use (OR 11.55, p = 0.005), CSF leak (OR 48.03, p < 0.001), and ventricular drainage (OR 70.52, p < 0.001). CONCLUSIONS Device-related postoperative communication between the CSF and the environment, CSF leak, and perioperative steroid use were defined as risk factors for meningitis in this study. Ventilator-associated pneumonia was the most common infection overall. The offending pathogens presented a high level of resistance to several antibiotics.
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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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Imberti R, Iotti GA, Regazzi M. Intraventricular or intrathecal colistin for the treatment of central nervous system infections caused by multidrug-resistant Gram-negative bacteria. Expert Rev Anti Infect Ther 2014; 12:471-8. [PMID: 24597575 DOI: 10.1586/14787210.2014.896740] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Central nervous system infections caused by Gram-negative bacteria susceptible only to colistin are rare but life-threatening and increasing in prevalence. Given the current antibiotic development pipeline it is likely that the paucity of therapeutic options will continue for the next years. Colistin is an amphipathic bactericidal antibiotic which is administered systemically as colistin methanesulfonate (also known as colistimethate sodium). Colistin methanesulfonate is the inactive prodrug, and in cerebrospinal fluid undergoes spontaneous hydrolysis to colistin (the active form with antimicrobial activity). In this review, we describe and evaluate the clinical and experimental data supporting the use of intraventricular (IVT) or intrathecal (IT) colistin against multidrug-resistant Gram-negative infections of the central nervous system, describe the permeability of the blood-brain barrier to colistin, the pharmacokinetics of colistin after IVT administration of colistin methanesulfonate, its anti-endotoxin activity, discuss the opportunity to administer colistin intraventricularly or intrathecally and the dose regimen, and provide recommendations based on the available evidence.
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Affiliation(s)
- Roberto Imberti
- Direzione Scientifica, Fondazione IRCCS Policlinico S. Matteo, 27100 Pavia, Italy
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Ribes S, Meister T, Ott M, Redlich S, Janova H, Hanisch UK, Nessler S, Nau R. Intraperitoneal prophylaxis with CpG oligodeoxynucleotides protects neutropenic mice against intracerebral Escherichia coli K1 infection. J Neuroinflammation 2014; 11:14. [PMID: 24456653 PMCID: PMC3906862 DOI: 10.1186/1742-2094-11-14] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Accepted: 01/12/2014] [Indexed: 12/28/2022] Open
Abstract
Background Prophylaxis with unmethylated cytosine phosphate guanidine (CpG) oligodeoxynucleotides (ODN) protects against several systemic experimental infections. Escherichia coli is a major cause of Gram-negative neonatal bacterial meningitis and also causes meningitis and meningoencephalitis in older and immunocompromised patients. Methods Wild-type (wt) and Toll-like receptor 9 (TLR9)-deficient mice were rendered neutropenic by intraperitoneal administration of the anti-Ly-6G monoclonal antibody. Immunocompetent and neutropenic mice received intraperitoneal CpG ODN or vehicle 72 h prior to induction of E. coli K1 meningoencephalitis. Results Pre-treatment with CpG ODN significantly increased survival of neutropenic wt mice from 33% to 75% (P = 0.0003) but did not protect neutropenic TLR9-/- mice. The protective effect of CpG ODN was associated with an enhanced production of interleukin (IL)-12/IL-23p40 with sustained increased levels in serum and spleen at least for 17 days after conditioning compared to buffer-treated animals. CpG-treated neutropenic wt mice showed reduced bacterial concentrations and increased recruitment of Ly6ChighCCR2+ monocytes in brain and spleen 42 h after infection. The levels of macrophage inflammatory protein 1α (MIP-1α) and interferon gamma (IFN-γ) in spleen were higher 42 h after infection in CpG-treated compared to buffer-treated neutropenic animals. In immunocompetent mice, prophylaxis with CpG ODN did not significantly increase survival compared to the buffer group (60% vs. 45%, P = 0.2). Conclusions These findings suggest that systemic administration of CpG ODN may help to prevent bacterial CNS infections in immunocompromised individuals.
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Affiliation(s)
- Sandra Ribes
- Institute of Neuropathology, University Medical Center Göttingen, Göttingen, Germany.
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Barichello T, Simões LR, Valvassori SS, Generoso JS, Aveline PEDV, Dominguini D, Elias SG, Vilela MC, Quevedo J, Teixeira AL. Klebsiella pneumoniae meningitis induces memory impairment and increases pro-inflammatory host response in the central nervous system of Wistar rats. J Med Microbiol 2013; 63:111-117. [PMID: 24105840 DOI: 10.1099/jmm.0.063289-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Klebsiella pneumoniae meningitis has recently become an increasingly common cause of central nervous system infection. The invasion of bacteria within the subarachnoid space stimulates the release of pro-inflammatory cytokines and chemokines, triggering a host immune response. The aim of the present study was to evaluate memory and pro-inflammatory mediators at different times in the brains of adult Wistar rats with K. pneumoniae meningitis. The animals were sacrificed at 6, 12, 24, 48 and 96 h after meningitis induction. The hippocampus, frontal cortex and cerebrospinal fluid were isolated to determine the cytokine, chemokine and brain-derived neurotrophic factor (BDNF) levels. In the first 6 and 24 h following meningitis induction, there was a significant increase of the TNF-α, IL-1β, IL-6, cytokine-induced neutrophil chemoattractant-1 and BDNF levels in the central nervous system. Ten days after meningitis induction, cognitive memory was evaluated using an open-field task and step-down inhibitory avoidance task. In the control group, significant differences in behaviour were observed between the training and testing sessions for both tasks, demonstrating habituation and aversive memory. However, the meningitis group did not exhibit any difference between the training and testing sessions in either task, demonstrating memory impairment. As a result of these observations, we believe that the meningitis model may be a good research tool to study the biological mechanisms involved in the pathophysiology of this illness, while recognizing that animal models should be interpreted with caution before extrapolation to the clinic.
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Affiliation(s)
- Tatiana Barichello
- Laboratório de Microbiologia Experimental, Programa de Pós-Graduação em Ciências da Saúde, Unidade Acadêmica de Ciências da Saúde, Universidade do Extremo Sul Catarinense, Criciúma, SC, Brazil
| | - Lutiana R Simões
- Laboratório de Microbiologia Experimental, Programa de Pós-Graduação em Ciências da Saúde, Unidade Acadêmica de Ciências da Saúde, Universidade do Extremo Sul Catarinense, Criciúma, SC, Brazil
| | - Samira S Valvassori
- Laboratório de Neurociências, Programa de Pós-Graduação em Ciências da Saúde, Unidade Acadêmica de Ciências da Saúde, Universidade do Extremo Sul Catarinense, Criciúma, SC, Brazil
| | - Jaqueline S Generoso
- Laboratório de Microbiologia Experimental, Programa de Pós-Graduação em Ciências da Saúde, Unidade Acadêmica de Ciências da Saúde, Universidade do Extremo Sul Catarinense, Criciúma, SC, Brazil
| | - Paulo Eduardo D V Aveline
- Laboratório de Microbiologia Experimental, Programa de Pós-Graduação em Ciências da Saúde, Unidade Acadêmica de Ciências da Saúde, Universidade do Extremo Sul Catarinense, Criciúma, SC, Brazil
| | - Diogo Dominguini
- Laboratório de Neurociências, Programa de Pós-Graduação em Ciências da Saúde, Unidade Acadêmica de Ciências da Saúde, Universidade do Extremo Sul Catarinense, Criciúma, SC, Brazil
| | - Samuel G Elias
- Laboratório de Microbiologia Experimental, Programa de Pós-Graduação em Ciências da Saúde, Unidade Acadêmica de Ciências da Saúde, Universidade do Extremo Sul Catarinense, Criciúma, SC, Brazil
| | - Marcia C Vilela
- Laboratório de Imunofarmacologia, Departamento de Bioquímica e Imunologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - João Quevedo
- Laboratório de Neurociências, Programa de Pós-Graduação em Ciências da Saúde, Unidade Acadêmica de Ciências da Saúde, Universidade do Extremo Sul Catarinense, Criciúma, SC, Brazil
| | - Antonio Lucio Teixeira
- Laboratório de Imunofarmacologia, Departamento de Bioquímica e Imunologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
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Maskin LP, Capparelli F, Mora A, Hlavnicka A, Orellana N, Díaz MF, Wainsztein N, Del Castillo M. Cerebrospinal fluid lactate in post-neurosurgical bacterial meningitis diagnosis. Clin Neurol Neurosurg 2013; 115:1820-5. [PMID: 23810183 DOI: 10.1016/j.clineuro.2013.05.034] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Revised: 05/05/2013] [Accepted: 05/17/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Differential diagnosis between post-neurosurgical bacterial meningitis (PNBM) and aseptic meningitis is difficult. Inflammatory and biochemical cerebrospinal fluid (CSF) changes mimic those classically observed after CNS surgery. CSF lactate assay has therefore been proposed as a useful PNBM marker. OBJECTIVE To evaluate the diagnostic accuracy of CSF lactate as a PNBM marker in patients hospitalized after a neurosurgical procedure. METHODS Between July 2005 and June 2009, a prospective clinical study, in which all patients with clinical suspicion of PNBM were enrolled, was conducted at our neurosurgical Intensive Care Unit. PNBM diagnosis was categorized as proven, probable or negative before the analysis. RESULTS Seventy-nine patients, 51 males with a mean age of 50 years (range 32-68 years) were included. Surgery was elective in 76% patients, mostly for brain tumors (57%); thirty PNBM episodes were identified. CSF parameters were significantly different in glucose concentration (27 mg% vs. 73 mg%, p<0.001), lactate (8 mmol/L vs. 2.8 mmol/L, p<0.001), CSF neutrophil pleocytosis (850 mm(-3) vs. 10mm(-3), p<0.001), and protein levels (449 mg% vs. 98 mg%) between the PNBM and non-PNBM groups. The ROC curve that best fits PNBM diagnosis is lactate. CONCLUSION Increased CSF lactate is a useful PNBM marker, with better predictive value than CSF hypoglycorrhachia or pleocytosis. Lactate levels ≥ 4 mmol/L showed 97% sensitivity and 78% specificity, with a 97% negative predictive value.
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Affiliation(s)
- Luis Patricio Maskin
- Intensive Care Unit, Raúl Carrea Neurological Research Institute, FLENI, Buenos Aires, Argentina.
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17
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McFarland AJ, Grant GD, Perkins AV, Flegg C, Davey AK, Allsopp TJ, Renshaw G, Kavanagh J, McDermott CM, Anoopkumar-Dukie S. Paradoxical Role of 3-Methyladenine in Pyocyanin-Induced Toxicity in 1321N1 Astrocytoma and SH-SY5Y Neuroblastoma Cells. Int J Toxicol 2013; 32:209-18. [DOI: 10.1177/1091581813482146] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The role of autophagy in pyocyanin (PCN)-induced toxicity in the central nervous system (CNS) remains unclear, with only evidence from our group identifying it as a mechanism underlying toxicity in 1321N1 astrocytoma cells. Therefore, the aim of this study was to further examine the role of autophagy in PCN-induced toxicity in the CNS. To achieve this, we exposed 1321N1 astrocytoma and SH-SY5Y neuroblastoma cells to PCN (0-100 μmol/L) and tested the contribution of autophagy by measuring the impact of the autophagy inhibitor 3-methyladenine (3-MA) using a series of biochemical and molecular markers. Pretreatment of 1321N1 astrocytoma cells with 3-MA (5 mmol/L) decreased the PCN-induced acidic vesicular organelle and autophagosome formation as measured using acridine orange and green fluorescent protein-LC3 -LC3 fluorescence, respectively. Furthermore, 3-MA (5 mmol/L) significantly protected 1321N1 astrocytoma cells against PCN-induced toxicity. In contrast pretreatment with 3-MA (5 mmol/L) increased PCN-induced toxicity in SH-SY5Y neuroblastoma cells. Given the influence of autophagy in inflammatory responses, we investigated whether the observed effects in this study involved inflammatory mediators. The PCN (100 μmol/L) significantly increased the production of interleukin-8 (IL-8), prostaglandin E2 (PGE2), and leukotriene B4 (LTB4) in both cell lines. Consistent with its paradoxical role in modulating PCN-induced toxicity, 3-MA (5 mmol/L) significantly reduced the PCN-induced production of IL-8, PGE2, and LTB4 in 1321N1 astrocytoma cells but augmented their production in SH-SY5Y neuroblastoma cells. In conclusion, we show here for the first time the paradoxical role of autophagy in mediating PCN-induced toxicity in 1321N1 astrocytoma and SH-SY5Y neuroblastoma cells and provide novel evidence that these actions may be mediated by effects on IL-8, PGE2, and LTB4 production.
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Affiliation(s)
- Amelia J. McFarland
- Griffith Health Institute, Griffith University, Queensland, Australia
- School of Pharmacy, Griffith University, Queensland, Australia
| | - Gary D. Grant
- Griffith Health Institute, Griffith University, Queensland, Australia
- School of Pharmacy, Griffith University, Queensland, Australia
| | - Anthony V. Perkins
- Griffith Health Institute, Griffith University, Queensland, Australia
- School of Medical Science, Griffith University, Queensland, Australia
| | - Cameron Flegg
- Griffith Health Institute, Griffith University, Queensland, Australia
- School of Medical Science, Griffith University, Queensland, Australia
| | - Andrew K. Davey
- Griffith Health Institute, Griffith University, Queensland, Australia
- School of Pharmacy, Griffith University, Queensland, Australia
| | - Tristan J. Allsopp
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Gillian Renshaw
- School of Physiotherapy and Exercise Science, Griffith University, Gold Coast Campus, Queensland, Australia
| | - Justin Kavanagh
- School of Physiotherapy and Exercise Science, Griffith University, Gold Coast Campus, Queensland, Australia
| | | | - Shailendra Anoopkumar-Dukie
- Griffith Health Institute, Griffith University, Queensland, Australia
- School of Pharmacy, Griffith University, Queensland, Australia
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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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19
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Weyrich P, Ettahar N, Legout L, Meybeck A, Leroy O, Senneville E. First initial community-acquired meningitis due to extended-spectrum beta-lactamase producing Escherichia coli complicated with multiple aortic mycotic aneurysms. Ann Clin Microbiol Antimicrob 2012; 11:4. [PMID: 22321435 PMCID: PMC3297508 DOI: 10.1186/1476-0711-11-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Accepted: 02/09/2012] [Indexed: 11/20/2022] Open
Abstract
We report the first case of extended-spectrum beta-lactamase producing E. coli community-acquired meningitis complicated with multiple aortic mycotic aneurysms. Because of the acute aneurysm expansion with possible impending rupture on 2 abdominal CT scan, the patient underwent prompt vascular surgery and broad spectrum antibiotic therapy but he died of a hemorrhagic shock. Extended-spectrum beta-lactamase producing E. coli was identified from both blood and cerebrospinal fluid culture before vascular treatment. The present case report does not however change the guidelines of Gram negative bacteria meningitis in adults.
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Affiliation(s)
- Pierre Weyrich
- Infectious diseases department, Dron hospital, Tourcoing, France
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20
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Nuñez-Villena F, Becerra A, Echeverría C, Briceño N, Porras O, Armisén R, Varela D, Montorfano I, Sarmiento D, Simon F. Increased expression of the transient receptor potential melastatin 7 channel is critically involved in lipopolysaccharide-induced reactive oxygen species-mediated neuronal death. Antioxid Redox Signal 2011; 15:2425-38. [PMID: 21539414 DOI: 10.1089/ars.2010.3825] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
AIMS To assess the mechanisms involved in lipopolysaccharide (LPS)-induced neuronal cell death, we examined the cellular consequences of LPS exposure in differentiated PC12 neurons and primary hippocampal neurons. RESULTS Our data show that LPS is able to induce PC12 neuronal cell death without the participation of glial cells. Neuronal cell death was mediated by an increase in cellular reactive oxygen species (ROS) levels. Considering the prevalent role of specific ion channels in mediating the deleterious effect of ROS, we assessed their contribution to this process. Neurons exposed to LPS showed a significant intracellular Ca(2+) overload, and nonselective cationic channel blockers inhibited LPS-induced neuronal death. In particular, we observed that both LPS and hydrogen peroxide exposure strongly increased the expression of the transient receptor protein melastatin 7 (TRPM7), which is an ion channel directly implicated in neuronal cell death. Further, both LPS-induced TRPM7 overexpression and LPS-induced neuronal cell death were decreased with dithiothreitol, dipheniliodonium, and apocynin. Finally, knockdown of TRPM7 expression using small interference RNA technology protected primary hippocampal neurons and differentiated PC12 neurons from the LPS challenge. INNOVATION This is the first report showing that TRPM7 is a key protein involved in neuronal death after LPS challenge. CONCLUSION We conclude that LPS promotes an abnormal ROS-dependent TRPM7 overexpression, which plays a crucial role in pathologic events, thus leading to neuronal dysfunction and death.
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Affiliation(s)
- Felipe Nuñez-Villena
- Departamento de Ciencias Biologicas, Facultad de Ciencias Biologicas, Universidad Andres Bello, Santiago, Chile
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21
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Inhibition of autophagy by 3-methyladenine protects 1321N1 astrocytoma cells against pyocyanin- and 1-hydroxyphenazine-induced toxicity. Arch Toxicol 2011; 86:275-84. [DOI: 10.1007/s00204-011-0755-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2011] [Accepted: 09/14/2011] [Indexed: 10/17/2022]
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22
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Influence of Third-generation Cephalosporin Resistance on Adult In-hospital Mortality From Post-neurosurgical Bacterial Meningitis. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2010; 43:301-9. [DOI: 10.1016/s1684-1182(10)60047-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2009] [Revised: 06/10/2009] [Accepted: 07/29/2009] [Indexed: 12/22/2022]
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23
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Briggs S, Ellis-Pegler R, Raymond N, Thomas M, Wilkinson L. Gram-negative Bacillary Meningitis after Cranial Surgery or Trauma in Adults. ACTA ACUST UNITED AC 2009; 36:165-73. [PMID: 15119359 DOI: 10.1080/00365540410027193] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
In order to assess the clinical features, aetiology, treatment and outcome of post-neurosurgical and post-traumatic Gram-negative bacillary meningitis (GNBM) we performed a retrospective review of all adult patients admitted to the Department of Neurosurgery who had Gram-negative bacilli cultured from cerebrospinal fluid (CSF) following a neurosurgical procedure or traumatic head/spinal injury. During the 12 y of the review 33 patients had CSF isolates of Gram-negative bacilli that were thought to be significant. The median patient age was 47 y (range 22-77 y) and 21 (64%) were male. Klebsiella pneumoniae, Enterobacter cloacae and Escherichia coli were the most common isolates. Minimal inhibitory concentrations (MIC) measured for half the patients' isolates resulted in 5 regimen changes, including 2 patients with E. cloacae meningitis in whom cephalosporin susceptibility decreased during cephalosporin treatment. Our recommended initial treatment was intravenous ceftriaxone and amikacin, subsequently tailored by susceptibility results; approximately half the patients remained on the antibiotics they started and half were changed to an alternate regimen, most often a carbapenem. Five patients (15%) died, 1 dying after cure of his GNBM. There were no failures in those who received more than 12 d of appropriate treatment: treatment for at least 14 d after the last positive CSF culture guaranteed cure. Initial ceftriaxone and amikacin subsequently changing to susceptibility driven alternatives, often a carbapenem, resulted in cure of 85% of our patients with GNBM.
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Affiliation(s)
- Simon Briggs
- Department of Infectious Diseases, Auckland Hospital, Auckland, New Zealand
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24
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Chen KJ, Sun MH, Hwang YS, Chen TL, Lai CC, Chen YP. Endophthalmitis Caused byCitrobacterSpecies. Ocul Immunol Inflamm 2009; 16:147-53. [DOI: 10.1080/09273940802184190] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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25
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Improving the role of intraventricular antimicrobial agents in the management of meningitis. Curr Opin Neurol 2009; 22:277-82. [PMID: 19434796 DOI: 10.1097/wco.0b013e32832c1396] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The aim is to review the role of intraventricular administration of antimicrobial agents in the treatment of patients with bacterial and fungal meningitis. RECENT FINDINGS This article discusses indications for intraventricular antimicrobial agents, choice of antibiotics, strategies to monitor pharmacokinetics of central nervous system compartments and unanswered issues for this management approach. SUMMARY Intraventricular administration of antimicrobials may be necessary in certain difficult- to- eradicate central nervous system infections. There is a significant need for clinical trials and management guidelines in this area.
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26
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Kuo CC, Wang JY, Chien JY, Chen YF, Wu VC, Tsai CW, Hwang JJ. Nontraumatic pneumocephalus due to nosocomial Enterobacter cloacae infection. Diagn Microbiol Infect Dis 2009; 66:108-10. [PMID: 19442474 DOI: 10.1016/j.diagmicrobio.2009.03.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2008] [Revised: 03/21/2009] [Accepted: 03/23/2009] [Indexed: 11/27/2022]
Abstract
Nosocomial meningitis is rare, and routine cerebrospinal fluid study is seldom recommended for hospitalized patients with fever and acute delirium. We present a case of Enterobacter cloacae meningitis complicated with a nontraumatic pneumocephalus. Maintaining a high index of suspicion of nosocomial meningitis is crucial in patients with acute delirium and multiple underlying comorbid conditions.
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Affiliation(s)
- Chin-Chi Kuo
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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27
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Chang WN, Lu CH, Huang CR, Tsai NW, Chuang YC, Chang CC, Chen SF, Chien CC. Changing epidemiology of adult bacterial meningitis in southern taiwan: a hospital-based study. Infection 2008; 36:15-22. [PMID: 18193387 DOI: 10.1007/s15010-007-7009-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2006] [Accepted: 08/15/2007] [Indexed: 11/27/2022]
Abstract
BACKGROUND Many factors may influence the epidemiologic trend of adult bacterial meningitis (ABM). The objective of this study was to analyze recent epidemiologic trends of ABM in order to provide a better therapeutic strategy. MATERIALS AND METHODS The clinical features, laboratory data, and therapeutic outcomes of 181 ABM cases collected in the last 6.5 years (July 1999-December 2005) were analyzed. The results were compared with those of our previous study (202 cases, January 1986-June 1999). RESULTS The 181 cases consisted of 130 men (age range: 18-82 years) and 51 women (age range: 18-78 years). Monomicrobial infection and mixed infection were found in 165 cases and 16 cases, respectively. A preceding postneurosurgical state was noted in 56.9% (103/181) of cases. Despite a decrease in incidence, Klebsiella pneumoniae (25.5%, 42/165) was still the most common pathogen. A marked increase of Acinetobacter meningitis (11.5%, 19/165) was noted, which replaced Pseudomonas meningitis as the second most common Gram-negative pathogen in ABM. A marked increase in staphylococcal infection, accounting for 23% (38/165) of all cases, was also noted, of which 76% (29/38) were methicillin-resistant strains. The therapeutic result showed a mortality rate of 30.3% (55/181). Significant prognostic factors included septic shock and age at infection. CONCLUSIONS This study revealed a change in the epidemiologic trend of ABM, with an increase in the number of patients with a postneurosurgical state and a rising incidence of Acinetobacter and staphylococcal infections. Clinicians should pay greater attention to these changes, which may affect their management of ABM.
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Affiliation(s)
- W-N Chang
- Department of Neurology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, #123 Ta Pei Road, Niao Sung Hsiang, Kaohsiung Hsien, 833, Taiwan, ROC.
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Veron W, Lesouhaitier O, Pennanec X, Rehel K, Leroux P, Orange N, Feuilloley MGJ. Natriuretic peptides affect Pseudomonas aeruginosa and specifically modify lipopolysaccharide biosynthesis. FEBS J 2007; 274:5852-64. [PMID: 17944935 DOI: 10.1111/j.1742-4658.2007.06109.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Natriuretic peptides of various forms are present in animals and plants, and display structural similarities to cyclic antibacterial peptides. Pretreatment of Pseudomonas aeruginosa PAO1 with brain natriuretic peptide (BNP) or C-type natriuretic peptide (CNP) increases bacterium-induced glial cell necrosis. In eukaryotes, natriuretic peptides act through receptors coupled to cyclases. We observed that stable analogs of cAMP (dibutyryl cAMP) and cGMP (8-bromo-cGMP) mimicked the effect of brain natriuretic peptide and CNP on bacteria. Further evidence for the involvement of bacterial cyclases in the regulation of P. aeruginosa PAO1 cytotoxicity by natriuretic peptides is provided by the observed doubling of intrabacterial cAMP concentration after exposure to CNP. Lipopolysaccharide (LPS) extracted from P. aeruginosa PAO1 treated with both dibutyryl cAMP and 8-bromo-cGMP induces higher levels of necrosis than LPS extracted from untreated bacteria. Capillary electrophoresis and MALDI-TOF MS analysis have shown that differences in LPS toxicity are due to specific differences in the structure of the macromolecule. Using a strain deleted in the vfr gene, we showed that the Vfr protein is essential for the effect of natriuretic peptides on P. aeruginosa PAO1 virulence. These data support the hypothesis that P. aeruginosa has a cyclic nucleotide-dependent natriuretic peptide sensor system that may affect virulence by activating the expression of Vfr and LPS biosynthesis.
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Affiliation(s)
- Wilfried Veron
- Laboratory of Cold Microbiology, UPRES 2123, University of Rouen, Evreux, France
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29
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Barker FG. Efficacy of Prophylactic Antibiotics Against Meningitis after Craniotomy: A Meta-Analysis. Neurosurgery 2007; 60:887-94; discussion 887-94. [PMID: 17460524 DOI: 10.1227/01.neu.0000255425.31797.23] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
OBJECTIVE
Although prophylactic antibiotics have been shown by randomized clinical trials (RCTs) to help prevent deep infection after craniotomies, recent reports have suggested that antibiotics are not effective in preventing postcraniotomy meningitis.
METHODS
Data on meningitis as an end point from RCTs on prophylactic antibiotics for craniotomies were pooled in a random-effects meta-analysis.
RESULTS
Six prospective randomized trials or trial subgroups enrolling 1729 patients or operations were identified. Antibiotics reduced postoperative infection rates in five of the six RCTs; no trial individually showed a statistically significant benefit from antibiotics. The pooled odds ratio for meningitis with antibiotic treatment in the six RCTs was 0.43 (95% confidence interval, 0.20–0.92; P = 0.03). Subgroup analyses showed no detectable difference in antibiotic efficacy if antibiotics, with or without gram- negative coverage, were used or if the trial was single or double blinded. A sensitivity analysis showed modest dependence of the results of the analysis on the specific definition of postoperative meningitis used in interpreting trial results.
CONCLUSION
Prophylactic antibiotics administered before craniotomy reduce rates of postoperative meningitis by approximately one-half, a statistically and clinically significant benefit.
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30
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Nicasio AM, Quintiliani R, DeRyke CA, Kuti JL, Nicolau DP. Treatment of Serratia marcescens meningitis with prolonged infusion of meropenem. Ann Pharmacother 2007; 41:1077-81. [PMID: 17472997 DOI: 10.1345/aph.1k060] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To describe the use of and cerebral spinal fluid (CSF) penetration of a prolonged infusion meropenem regimen in a patient with Serratia marcescens meningitis. CASE SUMMARY A 54-year-old female was diagnosed with S. marcescens meningitis associated with an epidural abscess 57 days after surgery for a herniated spinal disk. Meropenem 2000 mg every 8 hours was administered as a prolonged (3 h) infusion for the purpose of optimizing pharmacodynamic exposure. Meropenem concentrations were measured from the patient's blood and CSF (via a lumbar drain). The prolonged infusion regimen resulted in concentrations in both serum and CSF above the meropenem minimum inhibitory concentration (MIC) of 0.047 microg/mL for 100% of the dosing interval. After 6 days of therapy, the patient showed no further signs of infection and was subsequently discharged to a rehabilitation facility. At follow-up, she had completed a 4 week course of the prolonged infused therapy without relapse or adverse events. DISCUSSION Gram-negative infections of the central nervous system result in high morbidity and mortality. These infections are often difficult to treat because of poor antibiotic penetration coupled with increasing antibiotic resistance. Although there are 2 other case reports that describe the use of prolonged infusion of meropenem, our patient had a lumbar drain in place, thereby allowing us to collect multiple CSF samples and more accurately assess meropenem exposure at the site of infection. CSF penetration was 6.4% in this patient, resulting in 100% time above the MIC throughout the dosing interval. CONCLUSIONS In this patient with meropenem-susceptible S. marcescens meningitis, the use of a high-dose prolonged infusion of meropenem resulted in adequate exposure at the site of infection and a successful clinical response.
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Affiliation(s)
- Anthony M Nicasio
- Center for Anti-Infective Research and Development, Hartford Hospital, Hartford, CT 06102, USA
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Kourbeti IS, Jacobs AV, Koslow M, Karabetsos D, Holzman RS. Risk factors associated with postcraniotomy meningitis. Neurosurgery 2007; 60:317-25; discussion 325-6. [PMID: 17290182 DOI: 10.1227/01.neu.0000249266.26322.25] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The authors conducted a retrospective cohort study to determine the incidence, bacteriological features, and risk factors for postcraniotomy meningitis. METHODS Patients older than 18 years who underwent nonstereotactic craniotomies between January 1996 and March 2000 and who survived for more than 7 days were included. Operations for placement of burr holes and shunts were excluded. Records of the first 30 postoperative days were abstracted. Host factors, types of craniotomy, and pre- and postoperative variables were evaluated as risk factors for meningitis RESULTS Among 453 patients, there were 25 cases of meningitis. Eight out of 12 culture-positive cases were the result of gram-positive cocci. Four hundred twenty (92%) patients received antibiotic prophylaxis, most commonly a first-generation cephalosporin. In multivariate analysis, the risk of meningitis was increased by surgery that entered a sinus (odds ratio [OR], 4.49; P = 0.018), an increase in the American Society of Anesthesiologists score (OR, 1.72; P = 0.023), and increases in the number of days of external ventricular drainage (OR, 1.21; P = 0.049) and intracranial pressure monitoring (OR, 1.24; P = 0.002). CONCLUSION Access of upper airway bacteria to the surgical wound, host factors as expressed by the American Society of Anesthesiologists score, and duration of device-related postoperative communication of the cerebrospinal fluid and the environment are major risk factors for postoperative meningitis after craniotomy.
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Affiliation(s)
- Irene S Kourbeti
- Department of Internal Medicine, University Hospital of Crete and Graduate Program Medical School, University of Crete, Voutes, Heraklion, Greece
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Falagas ME, Bliziotis IA, Tam VH. Intraventricular or intrathecal use of polymyxins in patients with Gram-negative meningitis: a systematic review of the available evidence. Int J Antimicrob Agents 2007; 29:9-25. [PMID: 17126534 DOI: 10.1016/j.ijantimicag.2006.08.024] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2006] [Accepted: 08/08/2006] [Indexed: 11/30/2022]
Abstract
Several reports have described the use of polymyxins by the intraventricular or intrathecal route for multidrug-resistant Gram-negative meningitis. We reviewed the available clinical evidence regarding intraventricular/intrathecal administration of polymyxins in patients with meningitis, focusing on effectiveness and safety. Relevant studies were identified from PubMed (January 1950 to April 2006) as well as from the references of relevant articles. We identified 31 case reports/series that matched our inclusion criteria. Sixty-four episodes of Gram-negative meningitis (34 in adults) were reviewed. Monotherapy with polymyxins via the intraventricular or intrathecal route was used in 11 episodes and combination of systemic and local polymyxins was used in 25 episodes. In the remaining episodes, various combinations of local polymyxins with systemic and/or local antibiotics were administered. Cure was achieved in 51/64 episodes (80%); in 26/30 episodes (87%) due to Pseudomonas aeruginosa and in 10/11 episodes (91%) due to Acinetobacter spp. Toxicity related to local administration of polymyxins was noted in 17/60 (28%) patients. The most common toxicity was meningeal irritation (12 cases). Discontinuation of treatment was necessary in four episodes and dose reduction in four episodes; irreversible toxicity was not reported. The limited available evidence suggests that therapy with intraventricular/intrathecal polymyxins alone or in combination with systemic antimicrobial agents is effective against Gram-negative meningitis. Toxicity is not uncommon but it is dose-dependent and reversible. Further studies are needed to evaluate the criteria for initiation of local central nervous system treatment with polymyxins, the optimal dosages and the role of adjuvant systemic or local therapy.
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Affiliation(s)
- Matthew E Falagas
- Alfa Institute of Biomedical Sciences (AIBS), 9 Neapoleos Street, 151 23 Marousi, Athens, Greece.
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Metan G, Alp E, Aygen B, Sumerkan B. Carbapenem-resistant Acinetobacter baumannii: an emerging threat for patients with post-neurosurgical meningitis. Int J Antimicrob Agents 2007; 29:112-3. [PMID: 17134880 DOI: 10.1016/j.ijantimicag.2006.08.035] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2006] [Revised: 08/17/2006] [Accepted: 08/17/2006] [Indexed: 11/17/2022]
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Kallel H, Chelly H, Ghorbel M, Bahloul M, Ksibi H, Rekik N, Ben Mansour H, Bouaziz M. La méningite post-traumatique : incidence, microbiologie et pronostic. Neurochirurgie 2006; 52:397-406. [PMID: 17185945 DOI: 10.1016/s0028-3770(06)71238-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The aim of our study was to search for the incidence, the responsible organisms and the favoring causes of death of post-traumatic meningitis (PTM). METHODS This retrospective study was conducted over a seven-year period (January 1st, 1996 - December 31, 2002) in the ICU and the neurosurgery department of the Habib-Bourguiba University Hospital, Sfax, Tunisia. RESULTS Over the study period, 38 patients presented PTM (0.96% of patients hospitalized for head injury), 92% of them had received antibiotic prophylaxis on admission. Mean time between head injury and the diagnosis of PTM was 9+/- 8 days (range: 2-34 days). The most common isolated organisms were multidrug resistant A. baumanii, and K. pneumoniae and reduced susceptibility S. pneumoniae. Factors predictive of prognosis in the 14 days following the diagnosis of meningitis were Glasgow coma score (GCS) on the day of diagnosis of PTM, absence of nuchal rigidity, CSF protein, CSF/blood glucose ratio, and S. pneumoniae as the causal agent of PTM. CONCLUSIONS Antibioprophylaxis in patients with head trauma must be avoided to prevent the emergence of multidrug resistant bacteria when PTM occurs. GCS on the day of diagnosis of PTM, CSF protein concentration, CSF/blood glucose ratio, and S. pneumoniae as the causal agent of PTM are predictive factors of mortality of patients with PTM.
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Affiliation(s)
- H Kallel
- Service de Réanimation Médicale, CHU Habib-Bourguiba, route El-Aïn, km 1, 3029 Sfax, Tunisie.
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Korinek AM, Baugnon T, Golmard JL, van Effenterre R, Coriat P, Puybasset L. Risk Factors for Adult Nosocomial Meningitis After Craniotomy Roleof Antibiotic Prophylaxis. Neurosurgery 2006; 59:126-33; discussion 126-33. [PMID: 16823308 DOI: 10.1227/01.neu.0000220477.47323.92] [Citation(s) in RCA: 150] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To evaluate incidence and risk factors of postoperative meningitis, with special emphasis on antibiotic prophylaxis, in a series of 6243 consecutive craniotomies. METHODS Meningitis was individualized from a prospective surveillance database of surgical site infections after craniotomy. Ventriculitis related to external ventricular drainage or cerebrospinal fluid shunt were excluded. From May 1997 until March 1999, no antibiotic prophylaxis was prescribed for scheduled, clean, lasting less than 4 hours craniotomies, whereas emergency, clean-contaminated, or long-lasting craniotomies received cloxacillin or amoxicillin-clavulanate. From April 1999 until December 2003, prophylaxis was given to every craniotomy. Independent risk factors for meningitis were studied by a multivariate analysis. Efficacy of antibiotic prophylaxis in preventing meningitis was studied as well as consequences on bacterial flora. RESULTS The overall meningitis rate was 1.52%. Independent risk factors were cerebrospinal fluid leakage, concomitant incision infection, male sex, and surgical duration. Antibiotic prophylaxis reduced incision infections from 8.8% down to 4.6% (P < 0.0001) but did not prevent meningitis: 1.63% in patients without antibiotic prophylaxis and 1.50% in those who received prophylaxis. Bacteria responsible for meningitis were mainly noncutaneous in patients receiving antibiotics and cutaneous in patients without prophylaxis. In the former, microorganisms tended to be less susceptible to the prophylactic antibiotics administered. Mortality rate was higher in meningitis caused by noncutaneous bacteria as compared with those caused by cutaneous microorganisms. CONCLUSION Perioperative antibiotic prophylaxis, although clearly effective for the prevention of incision infections, does not prevent meningitis and tends to select prophylaxis resistant microorganisms.
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Affiliation(s)
- Anne-Marie Korinek
- Neuro-anesthesia Unit, Department of Anesthesiology, Pitié-Salpêtrière Hospital, University of Paris VI, Paris, France.
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Buke C, Sipahi OR, Yurtseven T, Zileli M. High dose of intrathecal netilmicin in the treatment of nosocomial Acinetobacter baumannii meningitis. J Infect 2006; 51:420-2. [PMID: 16321655 DOI: 10.1016/j.jinf.2005.02.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2005] [Accepted: 02/08/2005] [Indexed: 10/25/2022]
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Wang KW, Chang WN, Chang HW, Wang HC, Lu CH. Clinical relevance of hydrocephalus in bacterial meningitis in adults. ACTA ACUST UNITED AC 2005; 64:61-5; discussion 66. [PMID: 15993186 DOI: 10.1016/j.surneu.2004.10.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2004] [Accepted: 09/02/2004] [Indexed: 01/30/2023]
Abstract
BACKGROUND The predictive factors, clinical relevance, and outcomes of hydrocephalus complicating adult bacterial meningitis were studied. METHODS In this 16-year retrospective study, 136 adult patients were identified with culture-proven bacterial meningitis. A comparison was made between the clinical and cerebrospinal fluid data of patients with and without hydrocephalus on admission. RESULTS Twenty-eight patients had hydrocephalus secondary to bacterial meningitis, accounting for 21% (28/136) of the episodes. Of the 28 patients, the initial computed tomographic scans and/or magnetic resonance imaging studies revealed hydrocephalus in 27 patients, and delayed hydrocephalus developed despite commencement of antimicrobial therapy in the remaining patient. The interval from initial symptoms to external ventricular drainage was 3.9 +/- 4.6 days (range, 1-14 days). Among them, 7 patients underwent external ventricular drainage for hydrocephalus during the acute phase of bacterial meningitis. At follow-up of at least 6 months or more, 14 patients survived and 14 died, with an overall mortality rate of 50%. CONCLUSION In this study, disturbed consciousness and a higher mean age at the time of admission are risk factors for developing hydrocephalus during the acute phase of bacterial meningitis. Poor outcomes are also found in this specific group of patients, and these may be attributed to the infection itself, hydrocephalus, or both. Because of fulminated clinical courses and high fatality rates, surgical intervention may be suitable only for those who have progressive hydrocephalus and are neurologically stable. In spite the high fatality rate, adequate treatment of neurologic complications and aggressive antimicrobial therapy are essential in improving therapeutic outcomes.
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Affiliation(s)
- Kuo-Wei Wang
- Department of Neurosurgery, Chang Gung Memorial Hospital-Kaohsiung, Kaohsiung Hsien, Taiwan
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Kasiakou SK, Rafailidis PI, Liaropoulos K, Falagas ME. Cure of post-traumatic recurrent multiresistant Gram-negative rod meningitis with intraventricular colistin. J Infect 2005; 50:348-52. [PMID: 15845435 DOI: 10.1016/j.jinf.2004.05.008] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2004] [Indexed: 11/23/2022]
Abstract
A 28-year-old man developed five episodes of meningitis, all due to multiresistant Gram-negative rods during his 7-month hospitalisation after head trauma. This patient's recurrent meningitis was solved only when colistin and amikacin were given by the intraventricular in addition to the intravenous route for a long period of time, specifically 6 weeks.
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Dhawan B, Das BK, Mathur P, Kapil A. Bacteriological profile of post-neurosurgical meningitis in Indian children. Trop Doct 2004; 34:58-9. [PMID: 14959989 DOI: 10.1177/004947550403400132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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40
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Picot L, Chevalier S, Mezghani-Abdelmoula S, Merieau A, Lesouhaitier O, Leroux P, Cazin L, Orange N, Feuilloley MGJ. Cytotoxic effects of the lipopolysaccharide from Pseudomonas fluorescens on neurons and glial cells. Microb Pathog 2003; 35:95-106. [PMID: 12927517 DOI: 10.1016/s0882-4010(03)00092-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Pseudomonas fluorescens is an emerging pathogen closely related to Pseudomonas aeruginosa. In the present study, the effect of the lipopolysaccharide (LPS) from P. fluorescens MF37 was investigated using indicators of apoptosis and necrosis and was compared to the effect of the LPS from P. aeruginosa PAO1. Capillary electrophoresis analysis of the LPS from P. fluorescens MF37 revealed the existence of three forms of the endotoxin and the absence of homology with the LPS from P. aeruginosa. In neurons and glial cells the LPS from P. fluorescens induced major morphological changes including a condensation of the cytoplasmic proteins, a leakage of the cytoplasmic content, the formation of blebs on the nuclear membrane and a marked reorganization of the cytoskeleton. In glial cells, the LPS from P. fluorescens provoked the migration of phosphatidylserine at the surface of the cytoplasmic membrane, a sign of apoptosis, but this reaction was associated to an increase in the permeability to propidium iodide characteristic of necrosis. Biochemical studies revealed an important activation of an inducible nitric oxide synthase and a release of lactate dehydrogenase, a stable cytosolic enzyme. These results demonstrate that the LPS from P. fluorescens induces apoptosis and a concomitant and limited necrosis, reveal the unexpected cytotoxicity of this endotoxin and provide the first demonstration of the apoptotic effect of a non-aeruginosa Pseudomonas on nerve cells.
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Affiliation(s)
- Laurent Picot
- Laboratory of Cold Microbiology, University of Rouen, UPRES 2123, 55 rue Saint Germain, 27000 Evreux, France
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Kim PW, Harris AD, Roghmann MC, Morris JG, Strinivasan A, Perencevich EN. Epidemiological risk factors for isolation of ceftriaxone-resistant versus -susceptible citrobacter freundii in hospitalized patients. Antimicrob Agents Chemother 2003; 47:2882-7. [PMID: 12936989 PMCID: PMC182594 DOI: 10.1128/aac.47.9.2882-2887.2003] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Antimicrobial resistance is an emerging problem among nosocomial bacteria. Risk factors for the recovery of ceftriaxone-resistant (CRCF) or -susceptible (CSCF) Citrobacter freundii in clinical cultures from hospitalized patients were determined by using a case-case-control study design. CRCF was isolated from 43 patients (case group 1) and CSCF was isolated from 87 patients (case group 2) over a 3-year period. Risk factors for CRCF were exposure to imipenem (odds ratio [OR], 7.5; 95% confidence interval [CI], 1.2 to 45.4), broad-spectrum cephalosporins (OR, 6.9; 95% CI, 1.8 to 26.7), vancomycin (OR, 3.0; 95% CI, 1.2 to 7.4), or piperacillin-tazobactam (OR, 2.6; 95% CI, 1.1 to 6.2), as well as hospital length of stay >or=1 week (OR, 3.6; 95% CI, 1.3 to 10.2) and intensive care unit (ICU) stay (OR, 2.6; 95% CI, 1.1 to 6.2). Risk factors for CSCF were peripheral vascular disease (OR, 23.2; 95% CI, 4.3 to 124.6), AIDS (OR, 9.5; 95% CI, 1.6 to 55.5), cerebrovascular disease (OR, 4.2; 95% CI, 1.6 to 10.8), and ICU stay (OR, 3.1; 95% CI, 1.8 to 5.4).
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Affiliation(s)
- Peter W Kim
- Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA.
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Parodi S, Lechner A, Osih R, Vespa P, Pegues D. Nosocomial enterobacter meningitis: risk factors, management, and treatment outcomes. Clin Infect Dis 2003; 37:159-66. [PMID: 12856206 DOI: 10.1086/375596] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2002] [Accepted: 02/23/2003] [Indexed: 11/03/2022] Open
Abstract
Enterobacter species are increasingly a cause of nosocomial meningitis among neurosurgery patients, but risk factors for these infections are not well defined. A review of all adult patients hospitalized at the University of California-Los Angeles (UCLA) Medical Center during an 8-year period identified 15 postneurosurgical cases of Enterobacter meningitis (EM). Cure was achieved in 14 cases (93%), and efficacy was similar for carbapenem- and cephalosporin-based treatment. A matched case-control study comparing 26 controls with 13 case patients hospitalized exclusively at the UCLA Medical Center found that external cerebrospinal fluid (CSF) drainage devices (odds ratio [OR], 21.8; P=.001), isolation of Enterobacter species from a non-CSF culture (OR, 24.6; P=.002), and prolonged administration of antimicrobial drugs before the diagnosis of meningitis that were inactive in vitro against Enterobacter species (OR, 13.3; P=.008) were independent risk factors for EM. Despite favorable treatment outcomes, EM is a serious infection associated with Enterobacter species colonization or infection at other surgical sites, with selective antimicrobial pressure, and with invasive CNS devices.
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Affiliation(s)
- Stephen Parodi
- Division of Infectious Disease, Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
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Rau CS, Chang WN, Lin YC, Lu CH, Liliang PC, Su TM, Tsai YD, Chang CJ, Lee PY, Lin MW, Cheng BC. Brain abscess caused by aerobic Gram-negative bacilli: clinical features and therapeutic outcomes. Clin Neurol Neurosurg 2002; 105:60-5. [PMID: 12445926 DOI: 10.1016/s0303-8467(02)00103-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Thirty-three patients (24 males and nine females) with brain abscesses resulting from infection by aerobic Gram-negative bacilli were identified at Kaohsiung Chang Gung Memorial Hospital over a period of 14 years. Of these, 23 cases developed spontaneously, with the remaining ten postneurosurgery. The organisms most frequently involved were Klebsiella (K.) pneumoniae, Pseudomonas aeruginosa, Escherichia coli and Proteus species and included some rare pathogens, such as Salmonella and Enterobacter species, K. oxytoca, Vibrio and Morganella morganii. Apart from one exception, the locations of the abscess were supratentorial. Twenty-four patients presented with a single abscess, while nine revealed multiple abscesses, with 26 treated surgically and seven with antibiotics exclusively. In total, seven patients died, representing an overall mortality rate of 21%. This study demonstrates that brain abscesses associated with neurosurgical procedures are not rare, accounting for 30% of cases in this study, with K. pneumoniae, Proteus and Enterobacter species the most prevalent of the revealed pathogens. Further, Proteus species were the most prevalent pathogens demonstrated for cases of both otogenic and polymicrobial infections. If brain abscesses are diagnosed for diabetic patients or have a gas-forming appearance, a diagnosis of K. pneumoniae infection should be considered, with particular attention paid to detection of other metastatic septic abscesses. In light of the high mortality rate, early treatment is essential to maximize the chances of survival.
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Affiliation(s)
- Cheng-Shyuan Rau
- Department of Neurosurgery, Chang Gung Memorial Hospital, 123 Ta Pei Road, Niao Sung Hsiang, Kaohsiung Hsien, Taiwan, ROC
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Pepperell C, Kus JV, Gardam MA, Humar A, Burrows LL. Low-virulence Citrobacter species encode resistance to multiple antimicrobials. Antimicrob Agents Chemother 2002; 46:3555-60. [PMID: 12384364 PMCID: PMC128719 DOI: 10.1128/aac.46.11.3555-3560.2002] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Citrobacter spp. are gram-negative commensal bacteria that infrequently cause serious nosocomial infections in compromised hosts. They are often resistant to cephalosporins due to overexpression of their chromosomal beta-lactamase. During a recent study of multidrug-resistant Enterobacteriaceae (MDRE) in solid-organ transplant patients, we found that almost half of patients colonized with MDRE carried one or more cefpodoxime-resistant Citrobacter freundii, Citrobacter braakii, or Citrobacter amalonaticus strains. Pulsed-field gel electrophoresis showed that 36 unique strains of Citrobacter were present among 32 patients. Genetic and phenotypic analysis of the resistance mechanisms of these bacteria showed that the extended-spectrum beta-lactamase (ESBL) SHV-5 or SHV-12 was encoded by 8 strains (26%) and expressed by 7 strains (19%). A number of strains were resistant to other drug classes, including aminoglycosides (28%), trimethoprim-sulfamethoxazole (31%), and fluoroquinolones (8%). PCR and DNA analysis of these multiresistant strains revealed the presence of class I integrons, including the first integrons reported for C. braakii and C. amalonaticus. The integrons encoded aminoglycoside resistance, trimethoprim resistance, or both. Despite the prevalence of MDR Citrobacter spp. in our solid-organ transplant patients, only a single infection with a colonizing strain was recorded over 18 months. Low-virulence Citrobacter spp., which can persist in the host for long periods, could influence pathogen evolution by accumulation of genes encoding resistance to multiple antimicrobial classes.
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Affiliation(s)
- C Pepperell
- The Centre for Infection and Biomaterials Research, Hospital for Sick Children Research Institute. Departments of Surgery. Medicine, University of Toronto, Toronto, Ontario, Canada
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Radaelli ST, Platt SR. Bacterial Meningoencephalomyelitis in Dogs: A Retrospective Study of 23 Cases (1990-1999). J Vet Intern Med 2002. [DOI: 10.1111/j.1939-1676.2002.tb02348.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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46
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Samonis G, Anatoliotaki M, Apostolakou H, Souglakos J, Georgoulias V. Fatal septicemia and meningitis due to Morganella morganii in a patient with Hodgkin's disease. SCANDINAVIAN JOURNAL OF INFECTIOUS DISEASES 2002; 33:553-5. [PMID: 11515771 DOI: 10.1080/00365540110026665] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
A unique case of spontaneous Morganella morganii meningitis in a patient with stage IV Hodgkin's disease, following hematogenous spread from the urinary tract, is described. Late initiation of appropriate antibiotic treatment was probably responsible for the fatal outcome. This case illustrates the pathogenic potential of M. morganii in immunocompromised hosts.
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Affiliation(s)
- G Samonis
- Department of Medical Oncology, University General Hospital of Heraklion, Crete, Greece
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47
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Rodríguez Guardado A, Maradona JA, Asensi V, Cartón JA, Pérez F, Blanco A, Arribas JM. [Postsurgical meningitis caused by Acinetobacter baumannii: study of 22 cases and review of the literature]. Rev Clin Esp 2001; 201:497-500. [PMID: 11692403 DOI: 10.1016/s0014-2565(01)70895-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Postsurgical Acinetobacter baumannii meningitis is associated with relevant morbidity and mortality. It has been related to neurosurgery, intraventricular catheters (IC) or CSF fistula. Thus, features, epidemiology and clinical course of this infection were studied. METHODS Retrospective analysis of 22 episodes of nosocomial postsurgical Acinetobacter baumannii meningitis. Twenty episodes occurred in males. The mean age of patients was 46 years (range: 16-83 years). RESULTS All patients were admitted to the ICU. In 50% of patients a history of intraventricular hemorrhage was recorded, 36% had had a skull fracture and the remaining patients had a brain tumor. In 18 cases the portal of entry was considered to be IC, in two an epidural catheter, and in two a CSF fistula. Patients showed a clinical picture indistinguishable from other types of meningitis, fever being the most common symptom (100%). CSF findings were consistent with bacterial meningitis. In one case the microorganism was recovered from blood. Fifteen patients recovered, three died as a direct result of the infection, and the remaining patients relapsed. Non recovery of patients was significantly associated with non removal of catheter (p < 0.05). CONCLUSIONS Postsurgical Acinetobacter baumannii meningitis occurs frequently in patients previously colonized with this microorganism in other sites and is enhanced by the presence of an IC. Catheter removal is essential for recovery of patients.
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