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Kraef C, Hertz FB, Riis Olesen B, Sigurdsson ST, Bergdal OK, Gitz Holler J, Mens H, Helweg-Larsen J, Andersen ÅB, Møller K, Knudsen JD. Empiric treatment of healthcare-associated central nervous system infections in Denmark: do we need carbapenems? Infect Dis (Lond) 2024; 56:402-409. [PMID: 38339990 DOI: 10.1080/23744235.2024.2315478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 02/02/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Carbapenems are widely used for empiric treatment of healthcare-associated central nervous system (CNS) infections. We investigated the feasibility of a carbapenem-sparing strategy, utilising a third-generation cephalosporin (ceftriaxone or cefotaxime) (combined with vancomycin) for the empirical treatment of healthcare-associated CNS infections in Eastern Denmark. METHODS The departments of neurosurgery and neuro-intensive care at Copenhagen University Hospital Rigshospitalet. First, we analysed local microbiological data (1st January 2020-31st August 2022) to identify microorganisms non-susceptible to third-generation cephalosporin. Subsequently, we assessed all carbapenem prescriptions over a three-month period for their indication and justification. RESULTS In total, 25,247 bacterial cultures were identified, of which 2,563 CNS-related, were included in the analysis. The positivity rate was 10.5% (n = 257/2439) for cerebrospinal-fluid samples and 75.8% (n = 95/124) for brain parenchyma. CNS samples from five individual patients revealed bacteria non-susceptible to third generation cephalosporins (Enterobacter spp. (n = 3), Pseudomonas spp. (n = 2), Klebsiella spp. (n = 2), Citrobacter freundii (n = 1)). All five patients had been hospitalised for ≥10days at the time-point of antibiotic therapy. Out of 11,626 sets of blood cultures, a total of 10 individual patients had Gram-negative blood-stream infections with resistance to ceftriaxone and piperacillin/tazobactam. 140 days-of-therapy (32%) with carbapenem in 18 patients (36%) were definitively or possibly indicated according to guidelines, none were indicated for healthcare-associated CNS-infections. CONCLUSION An empiric treatment strategy relying on a third-generation cephalosporin appears suitable for healthcare-associated CNS infections at our tertiary hospital, serving a population of 2.6 million. However, in patients with prolonged hospitalization (≥10 days), immunosuppression, prior broad-spectrum antibiotic use, or history of resistant Gram-negative bacteria, empirical prescription of carbapenem may be needed.
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Affiliation(s)
- Christian Kraef
- Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Kobenhavn, Denmark
| | - Frederik Boetius Hertz
- Department of Clinical Microbiology, Copenhagen University Hospital - Rigshospitalet, Kobenhavn, Denmark
- Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Birthe Riis Olesen
- Hospital Administration/Pharmacy, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Sigurdur Thor Sigurdsson
- Department of Neuroanesthesiology, Copenhagen University Hospital - Rigshospitalet, Kobenhavn, Denmark
| | - Ove Ketil Bergdal
- Department of Neurosurgery, Copenhagen University Hospital - Rigshospitalet, Kobenhavn, Denmark
| | - Jon Gitz Holler
- Department of Infectious Diseases, Copenhagen University Hospital - North Zealand, Kobenhavn, Denmark
| | - Helene Mens
- Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Kobenhavn, Denmark
| | - Jannik Helweg-Larsen
- Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Kobenhavn, Denmark
| | - Åse Bengaard Andersen
- Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Kobenhavn, Denmark
| | - Kirsten Møller
- Department of Neuroanesthesiology, Copenhagen University Hospital - Rigshospitalet, Kobenhavn, Denmark
| | - Jenny Dahl Knudsen
- Department of Clinical Microbiology, Copenhagen University Hospital - Rigshospitalet, Kobenhavn, Denmark
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Chojak R, Koźba-Gosztyła M, Gaik M, Madej M, Majerska A, Soczyński O, Czapiga B. Meningitis after elective intracranial surgery: a systematic review and meta-analysis of prevalence. Eur J Med Res 2023; 28:184. [PMID: 37291583 DOI: 10.1186/s40001-023-01141-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 05/15/2023] [Indexed: 06/10/2023] Open
Abstract
Meningitis is a potential complication of elective intracranial surgery (EIS). The prevalence of meningitis after EIS varies greatly in the literature. The objective of this study was to estimate the overall pooled prevalence of meningitis following EIS. Four databases (PubMed, Scopus, Web of Science, and Embase) were searched to identify relevant studies. Meta-analyses of proportions were used to combine data. Cochran's Q and I2 statistics were used to assess and quantify heterogeneity. Additionally, several subgroup analyses were conducted to investigate the source of heterogeneity and examine differences in the prevalence based on variables such as geographical regions, income level, and meningitis type. The meta-analysis included 83 studies (30 959 patients) from 26 countries. The overall pooled prevalence of meningitis after EIS was 1.6% (95% CI 1.1-2.1), with high heterogeneity present (I2 = 88%). The pooled prevalence in low- to middle-income countries and high-income countries was 2.7% (95% CI 1.6-4.1) and 1.2% (95% CI 0.8-1.7), respectively. Studies that reported only aseptic meningitis had a pooled prevalence of 3.2% (95% CI 1.3-5.8). The pooled prevalence was 2.8% (95% CI 1.5-4.5) in studies that reported only bacterial meningitis. Similar prevalence rates of meningitis were observed in the subgroups of tumor resection, microvascular decompression, and aneurysm clipping. Meningitis is a rare but not exceptional complication following EIS, with an estimated prevalence of 1.6%.
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Affiliation(s)
- Rafał Chojak
- Faculty of Medicine, Wroclaw Medical University, Ludwika Pasteura 1, 50-367, Wrocław, Poland.
| | | | - Magdalena Gaik
- Faculty of Medicine, Wroclaw Medical University, Ludwika Pasteura 1, 50-367, Wrocław, Poland
| | - Marta Madej
- Faculty of Medicine, Wroclaw Medical University, Ludwika Pasteura 1, 50-367, Wrocław, Poland
| | - Aleksandra Majerska
- Faculty of Medicine, Wroclaw Medical University, Ludwika Pasteura 1, 50-367, Wrocław, Poland
| | - Oskar Soczyński
- Faculty of Medicine, Wroclaw Medical University, Ludwika Pasteura 1, 50-367, Wrocław, Poland
| | - Bogdan Czapiga
- Department of Neurosurgery, 4th Military Hospital in Wroclaw, Wrocław, Poland
- Department of Nervous System Diseases, Faculty of Health Sciences, Wroclaw Medical University, Wrocław, Poland
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Olguner SK, Boyar B, Alabaz D, Erman T, Oktay K, Arslan A, Bilgin E, Okten AI. Tumor necrosis factor alpha and interleukin-1 beta levels in cerebrospinal fluid examination for the diagnosis of ventriculoperitoneal shunt-related ventriculitis. Childs Nerv Syst 2019; 35:629-636. [PMID: 30687902 DOI: 10.1007/s00381-019-04070-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 01/20/2019] [Indexed: 01/01/2023]
Abstract
PURPOSE Ventriculitis is known to develop after chronic inflammation and bacterial invasion of the ventricular surface with a recurrence of shunt infections. The aim of this study is to evaluate the diagnostic value of elevation in cerebrospinal fluid (CSF) interleukin-1 beta (IL-1β) and tumor necrosis factor alpha (TNF-α) together with CSF culture and laboratory test results in the diagnosis of ventriculoperitoneal (VP) shunt-related ventriculitis, which is known to be more problematic than conventional shunt infection. METHODS The study included a total of 34 patients with a VP shunt due to hydrocephalus, who presented with a headache, fever, and shunt infection at the Emergency Department and had a pre-diagnosis of ventriculitis. Nineteen patients were diagnosed with shunt-related infection or ventriculitis using the CSF obtained from the shunt pump. The IL-1β and TNF-α levels from the CSF samples of all patients were measured using the Micro ELISA immunoassay method. RESULTS CSF direct microscopic observation revealed that the mean cell count, IL-1β level, CRP level, and blood leukocyte level were higher in patients with ventriculitis compared to those diagnosed with shunt infection (p = 0.02, p = 0.009, p = 0.004, and p = 0.009, respectively). The probability of predicting positive culture outcome was 92.7% with 90.9% sensitivity and 82.6% specificity when IL-1β values exceeded 4.0 pg/ml. TNF-α values did not show a significant, reliable pattern compared to IL-1β. CONCLUSIONS IL-1β is a reliable parameter which shall be used in the diagnosis of ventriculitis by predicting positive culture outcome with high sensitivity and specificity.
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Affiliation(s)
- Semih K Olguner
- Department of Neurosurgery, Adana City Training Research Hospital, Adana, Turkey.
| | - Bulent Boyar
- Department of Neurosurgery, Cukurova University of Medical School, Adana, Turkey
| | - Derya Alabaz
- Pediatric Infectious Disease Department, Cukurova University of Medical School, Adana, Turkey
| | - Tahsin Erman
- Department of Neurosurgery, Cukurova University of Medical School, Adana, Turkey
| | - Kadir Oktay
- Department of Neurosurgery, Medical Park Hospital, Gaziantep, Turkey
| | - Ali Arslan
- Department of Neurosurgery, Adana City Training Research Hospital, Adana, Turkey
| | - Emre Bilgin
- Department of Neurosurgery, Adana City Training Research Hospital, Adana, Turkey
| | - Ali Ihsan Okten
- Department of Neurosurgery, Adana City Training Research Hospital, Adana, Turkey
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Simon TD, Schaffzin JK, Stevenson CB, Willebrand K, Parsek M, Hoffman LR. Cerebrospinal Fluid Shunt Infection: Emerging Paradigms in Pathogenesis that Affect Prevention and Treatment. J Pediatr 2019; 206:13-19. [PMID: 30528757 PMCID: PMC6389391 DOI: 10.1016/j.jpeds.2018.11.026] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 11/09/2018] [Accepted: 11/13/2018] [Indexed: 01/04/2023]
Affiliation(s)
- Tamara D. Simon
- Department of Pediatrics, University of Washington/Seattle Children’s Hospital, Seattle, Washington, United States,Center for Clinical and Translational Research, Seattle Children’s Research Institute, Seattle, Washington, United States
| | - Joshua K. Schaffzin
- Division of Infectious Diseases, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States
| | - Charles B. Stevenson
- Division of Pediatric Neurosurgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States
| | - Kathryn Willebrand
- Department of Microbiology, University of Washington, Seattle, Washington, United States
| | - Matthew Parsek
- Department of Microbiology, University of Washington, Seattle, Washington, United States
| | - Lucas R. Hoffman
- Department of Pediatrics, University of Washington/Seattle Children’s Hospital, Seattle, Washington, United States,Center for Clinical and Translational Research, Seattle Children’s Research Institute, Seattle, Washington, United States,Department of Microbiology, University of Washington, Seattle, Washington, United States,Center for Infection and Prematurity Research, Seattle Children’s Research Institute, Seattle, Washington, United States
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Tomio R, Akiyama T, Shibao S, Yoshida K. Procalcitonin as an Early Diagnostic Marker for Ventriculoperitoneal Shunt Infections. Surg Infect (Larchmt) 2013; 14:433-6. [DOI: 10.1089/sur.2012.087] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ryosuke Tomio
- Department of Neurosurgery, Saitama Municipal Hospital, Saitama, Japan
| | - Takenori Akiyama
- Department of Neurosurgery, School of Medicine, Keio University, Tokyo, Japan
| | - Shunsuke Shibao
- Department of Neurosurgery, School of Medicine, Keio University, Tokyo, Japan
| | - Kazunari Yoshida
- Department of Neurosurgery, School of Medicine, Keio University, Tokyo, Japan
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Uche EO, Onyia E, Mezue UC, Okorie E, Ozor II, Chikani MC. Determinants and outcomes of ventriculoperitoneal shunt infections in Enugu, Nigeria. Pediatr Neurosurg 2013; 49:75-80. [PMID: 24434896 DOI: 10.1159/000357384] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Accepted: 10/10/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND To evaluate the determinants and outcomes of shunt infection (SI). METHODS One hundred ninety-eight pediatric hydrocephalic patients treated with a ventriculoperitoneal (VP) shunt between January 2008 and August 2012 were retrospectively studied. Patients with SI were compared to those without SI in terms of the occurrence of risk factors and outcomes. Data was analyzed using Statistical Package for the Social Sciences software (version 15). RESULTS The age range was 2 weeks to 13 years, with a mean age of 3.1 ± 0.19 years for the SI group versus 2.7 ± 0.2 years for those without SI. One hundred and twelve patients were female and 86 were male. SI was recorded in 17 (8.6%) patients. Postinfective hydrocephalus (n = 6) was the most common cause of hydrocephalus in the SI group. Individuals in the SI group, compared to those without infection, were more likely to be underweight (χ2 = 23.4, p < 0.01). The mean interval between VP shunt placement and SI was 1.83 ± 1.25 months. Coagulase-negative Staphylococcus (29.4%) was the most common pathogen. The mortality rate in our series was 21.4% in patients with SI compared to 2.7% in those without SI. CONCLUSION Coagulase-negative Staphylococcus is currently the most common cause of SI and underweight children appear have a higher risk.
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Affiliation(s)
- E O Uche
- Neurological Surgery Unit, Department of Surgery, College of Medicine, University of Nigeria Teaching Hospital, Enugu, Nigeria
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Successful Use of Intrathecal Daptomycin to Treat Meningitis Due to Vancomycin-Resistant Enterococcus faecium. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2012. [DOI: 10.1097/ipc.0b013e3182506d8f] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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8
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Wu YM, Hsu PC, Yang CC, Chang HJ, Ye JJ, Huang CT, Lee MH. Serratia marcescens meningitis: epidemiology, prognostic factors and treatment outcomes. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2012; 46:259-65. [PMID: 22926070 DOI: 10.1016/j.jmii.2012.07.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Revised: 06/14/2012] [Accepted: 07/10/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND/PURPOSE Serratia marcescens is a rare pathogen of central nervous system infections. This study was to investigate the epidemiology, prognostic factors, and treatment outcomes of S. marcescens meningitis. METHODS This retrospective analysis included 33 patients with culture-proven S. marcescens meningitis hospitalized between January 2000 and June 2011. RESULTS Of the 33 patients enrolled, only one did not receive neurosurgery before the onset of S. marcescens meningitis. Patients with S. marcescens meningitis had higher ratios of brain solid tumors (54.5%) and neurosurgery (97.0%) with a mortality rate of 15.2%. The mean interval between the first neurosurgical procedure and the diagnosis of meningitis was 17.1 days (range, 4-51 days). Only one third-generation cephalosporin-resistant S. marcescens isolate was recovered from the patients' cerebrospinal fluid (CSF) specimens. Compared with the favorable outcome group (n = 20), the unfavorable outcome group (n = 13) had a higher percentage of brain solid tumors, more intensive care unit stays, and higher Sequential Organ Failure Assessment score, CSF lactate and serum C-reactive protein concentrations at diagnosis of meningitis. Under the multiple regression analysis, CSF lactate concentration ≥2-fold the upper limit of normal (ULN) was independently associated with unfavorable outcomes (odds ratio, 7.20; 95% confidence interval, 1.08-47.96; p = 0.041). CONCLUSION S. marcescens meningitis is highly associated with neurosurgical procedures for brain solid tumors. CSF lactate concentration ≥2x ULN may predict an unfavorable outcome. Its mortality is not high and empiric treatment with parenteral third-generation cephalosporins may have a satisfactory clinical response.
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Affiliation(s)
- Yen-Mu Wu
- Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
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Ryu SH, Yu CM, Suh SO, Kim JH, Ko YJ, Park JH, Cho JH. A Case of Community-AcquiredAcinetobacterMeningitis. Infect Chemother 2012. [DOI: 10.3947/ic.2012.44.6.473] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Seo Hee Ryu
- Department of Internal Medicine, National Police Hospital, Seoul, Korea
| | - Chang Min Yu
- Department of Internal Medicine, National Police Hospital, Seoul, Korea
| | - Seong O Suh
- Department of Internal Medicine, National Police Hospital, Seoul, Korea
| | - Jun Hwan Kim
- Department of Internal Medicine, National Police Hospital, Seoul, Korea
| | - Yu Jin Ko
- Department of Internal Medicine, National Police Hospital, Seoul, Korea
| | - Jae Hyun Park
- Department of Internal Medicine, National Police Hospital, Seoul, Korea
| | - Jae Hyun Cho
- Department of Internal Medicine, National Police Hospital, Seoul, Korea
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10
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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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11
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Infectious Disease. Neurosurgery 2010. [DOI: 10.1007/978-3-540-79565-0_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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12
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Sharma MS, Vohra A, Thomas P, Kapil A, Suri A, Chandra PS, Kale SS, Mahapatra AK, Sharma BS. EFFECT OF RISK‐STRATIFIED, PROTOCOL‐BASED PERIOPERATIVE CHEMOPROPHYLAXIS ON NOSOCOMIAL INFECTION RATES IN A SERIES OF 31 927 CONSECUTIVE NEUROSURGICAL PROCEDURES (1994–2006). Neurosurgery 2009; 64:1123-30; discussion 1130-1. [DOI: 10.1227/01.neu.0000345645.51847.61] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Manish S. Sharma
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Ashma Vohra
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Ponnamma Thomas
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Arti Kapil
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Ashish Suri
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - P. Sarat Chandra
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Shashank S. Kale
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Ashok K. Mahapatra
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Bhawani S. Sharma
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
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Lietard C, Thébaud V, Besson G, Lejeune B. Risk factors for neurosurgical site infections: an 18-month prospective survey. J Neurosurg 2008; 109:729-34. [PMID: 18826362 DOI: 10.3171/jns/2008/109/10/0729] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The purpose of this study was to determine the incidence rate and risk factors of surgical site infections (SSIs) in neurosurgery for any type of surgery and any American Society of Anesthesiologists class. METHODS The authors undertook an exhaustive 18-month prospective survey including patients who underwent neurosurgery. In particular, a 30-day follow-up was completed in patients whose surgery did not involve placement of a prosthesis or implant, and 1-year follow-up was completed for patients who underwent surgery to place a prosthesis or implant. The Centers for Disease Control definition of SSI was used. Univariate and multivariate analyses were conducted; all dependent variables found in univariate analysis were entered in the multiple regression model. A stepwise multiple logistic regression method was used. RESULTS Of the 844 patients studied, 35 SSIs were diagnosed, yielding an incidence rate of 4.1% (95% confidence interval 3.6-4.5). Independent predictive risk factors for infection were cerebrospinal fluid leakage, external shunt, Altemeier class, and further neurosurgery. A lack of antibiotic prophylaxis was not found to be a risk factor. CONCLUSIONS Infection risk factors occur mainly during the postoperative period.
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Affiliation(s)
- Claire Lietard
- Laboratoire Universitaire de Santé Publique et Epidémiologie, Faculté de Médecine et Sciences de la Santé de Brest, UBO, and, Service de Santé Publique, Hygiène Hospitalière, Evaluation, CHU Brest, France.
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Ye G, Cai X, Wang B, Zhou Z, Yu X, Wang W, Zhang J, Wang Y, Dong J, Jiang Y. Simultaneous determination of vancomycin and ceftazidime in cerebrospinal fluid in craniotomy patients by high-performance liquid chromatography. J Pharm Biomed Anal 2008; 48:860-5. [DOI: 10.1016/j.jpba.2008.06.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2008] [Revised: 06/06/2008] [Accepted: 06/16/2008] [Indexed: 12/01/2022]
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15
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Miller JP, Fulop SC, Dashti SR, Robinson S, Cohen AR. Rethinking the indications for the ventriculoperitoneal shunt tap. J Neurosurg Pediatr 2008; 1:435-8. [PMID: 18518692 DOI: 10.3171/ped/2008/1/6/435] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Tapping of a suspected malfunctioning ventriculoperitoneal shunt is usually easy, sometimes informative, but also potentially misleading. The purpose of this study was to determine the effectiveness of a shunt evaluation protocol that does not involve direct shunt tapping except in rare and specific cases. METHODS The authors adopted a protocol for shunt evaluation that involves shunt tapping only in selected cases of suspected infection or in patients with noncommunicating hydrocephalus and equivocal computed tomography (CT) findings of shunt infection. They then reviewed the clinical characteristics and surgical findings in 373 consecutive assessments of 155 pediatric patients who were evaluated for shunt malfunction and/or infection by using this protocol between January 2003 and December 2005. RESULTS Mental status change and headache were the symptoms most concordant with shunt malfunction, but no symptom had a predictive value much better than 50%. Follow-up CT scans demonstrated enlarged ventricles in 72 of 126 cases of shunt revision. Among those with obstruction but without remarkable CT changes, 8 patients had evidence of distal obstruction on x-ray "shunt series" consisting of skull, chest, and abdominal radiographs, and 5 had obvious symptoms that rendered further testing unnecessary; 38 cases of obstruction were diagnosed based on elevated opening pressure on lumbar puncture (mean 34.7 cm H(2)O). A shunt tap was required in only 8 cases (2%). CONCLUSIONS The authors have shown that it is possible to evaluate the majority of ventricular shunt malfunctions without tapping the device. Because it is possible to diagnose shunt obstruction correctly by other means, the shunt tap may not be obligatory as a routine test of the device's patency.
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Affiliation(s)
- Jonathan P Miller
- Department of Neurological Surgery, University Hospitals of Cleveland, Cleveland, Ohio 44106, USA
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Deutch S, Dahlberg D, Hedegaard J, Schmidt MB, Møller JK, Ostergaard L. DIAGNOSIS OF VENTRICULAR DRAINAGE-RELATED BACTERIAL MENINGITIS BY BROAD-RANGE REAL-TIME POLYMERASE CHAIN REACTION. Neurosurgery 2007; 61:306-11; discussion 311-2. [PMID: 17762743 DOI: 10.1227/01.neu.0000255526.34956.e4] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
OBJECTIVE
To compare a broad-range real-time polymerase chain reaction (PCR) diagnostic strategy with culture to evaluate additional effects on the etiological diagnosis and the quantification of the bacterial load during the course of ventricular drainage-related bacterial meningitis (VR-BM).
METHODS
We applied a PCR that targeted conserved regions of the 16S ribosomal ribonucleic acid gene to cerebrospinal fluid (CSF) samples from patients with external ventricular drainage or a ventriculoperitoneal shunt during the course of VR-BM. We compared the PCR results with CSF cultures. A total of 350 routine CSF samples were consecutively collected from 86 patients. The CSF deoxyribonucleic acid was automatically purified and subjected to PCR. Amplicons from the PCR samples that were positive for VR-BM were subsequently deoxyribonucleic acid sequenced for final identification. Clinical data were extracted from patient files.
RESULTS
Sixteen patients had at least one VR-BM-positive sample as diagnosed from culture or PCR. Nineteen episodes were diagnosed with signs of VR-BM (n = 16 patients) or were determined to be contaminated (n = 3 patients). Four episodes of VR-BM were diagnosed via PCR alone and were predominantly caused by gram-negative pathogens, five episodes were diagnosed via culture alone, and seven episodes were diagnosed via both culture and PCR. Five patients had mixed infections. Overall, 71 samples were positive for VR-BM as indicated by either one or both of the methods. Eighteen CSF samples were VR-BM positive as indicated by culture alone, and 21 CSF samples were positive as indicated via PCR alone.
CONCLUSIONS
Culture supplemented with broad-range, real-time PCR may increase the number of etiologically diagnosed VR-BM episodes, particularly when these are caused by gram-negative bacteria.
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Affiliation(s)
- Susanna Deutch
- Department of Infectious Diseases, Skejby Sygehus, Aarhus University Hospital, Aarhus, Denmark.
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Lima MMM, Pereira CU, Silva AM. Infecções em dispositivos neurológicos implantáveis em crianças e adolescentes. ARQUIVOS DE NEURO-PSIQUIATRIA 2007; 65:118-23. [PMID: 17420840 DOI: 10.1590/s0004-282x2007000100024] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2006] [Accepted: 10/31/2006] [Indexed: 11/22/2022]
Abstract
OBJETIVO: Determinar a freqüência, as causas, o sítio específico e as manifestações clínicas e laboratoriais das infecções em crianças e adolescentes após a implantação de dispositivos neurológicos (DVP) no Hospital Governador João Alves Filho (Aracaju SE). MÉTODO: Estudo prospectivo, observacional, não controlado de 50 pacientes, submetidos a DVP (58 procedimentos), no período de janeiro de 2003 a outubro de 2004. RESULTADOS: Observaram-se taxas de infecção por procedimento de 27,6%, taxas de infecção de índice cirúrgico zero, 1 e 2 de 25,7% e 30,4%, respectivamente (NNIS-CDC). A infecção de sítio cirúrgico foi a principal complicação com 50% das infecções. CONCLUSÃO: Taxa de infecção por procedimento, paciente e índice de risco cirúrgico mostraram-se elevadas. Não houve significância estatística com relação à idade, etiologia da hidrocefalia, ao tipo de procedimento (derivação primária e reinserção), tempo de internação pré-operatória, duração da cirurgia, antibioticoprofilaxia, cateter SNC prévio e índice de risco cirúrgico.
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Affiliation(s)
- Márcia Maria Macêdo Lima
- Hospital Governador Joao Alves Filho, Universidade Federal de Sergipe, Avenida Sizino Martins Fontes 84/102, 49032-510 Aracaju, SE, Brazil.
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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; 59:126-133. [DOI: 10.1227/01.neu.0000243291.61566.21] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2006] [Accepted: 06/30/2006] [Indexed: 11/19/2022] Open
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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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Sacar S, Turgut H, Toprak S, Cirak B, Coskun E, Yilmaz O, Tekin K. A retrospective study of central nervous system shunt infections diagnosed in a university hospital during a 4-year period. BMC Infect Dis 2006; 6:43. [PMID: 16524475 PMCID: PMC1421408 DOI: 10.1186/1471-2334-6-43] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2005] [Accepted: 03/08/2006] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ventriculoperitoneal (VP) shunts are used for intracranial pressure management and temporary cerebrospinal fluid (CSF) drainage. Infection of the central nervous system (CNS) is a major cause of morbidity and mortality in patients with CSF shunts. The aim of the present study was to evaluate the clinical features, pathogens, and outcomes of 22 patients with CSF shunt infections collected over 4 years. METHODS The patients with shunt insertions were evaluated using; age, sex, etiology of hydrocephalus, shunt infection numbers, biochemical and microbiological parameters, prognosis, clinical infection features and clinical outcome. RESULTS The most common causes of the etiology of hydrocephalus in shunt infected patients were congenital hydrocephalus-myelomeningocele (32%) and meningitis (23%). The commonest causative microorganism identified was Staphylococcus (S.) aureus, followed by Acinetobacter spp., and S. epidermidis. CONCLUSION In a case of a shunt infection the timely usage of appropriate antibiotics, according to the antimicrobial susceptibility testing, and the removal of the shunt apparatus is essential for successful treatment.
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Affiliation(s)
- Suzan Sacar
- Department of Infectious Diseases and Clinical Microbiology, Pamukkale University, Faculty of Medicine, Denizli, Turkey
| | - Huseyin Turgut
- Department of Infectious Diseases and Clinical Microbiology, Pamukkale University, Faculty of Medicine, Denizli, Turkey
| | - Semra Toprak
- Department of Infectious Diseases and Clinical Microbiology, Pamukkale University, Faculty of Medicine, Denizli, Turkey
| | - Bayram Cirak
- Department of Neurosurgery, Pamukkale University, Faculty of Medicine, Denizli, Turkey
| | - Erdal Coskun
- Department of Neurosurgery, Pamukkale University, Faculty of Medicine, Denizli, Turkey
| | - Ozlem Yilmaz
- Department of Infectious Diseases and Clinical Microbiology, Pamukkale University, Faculty of Medicine, Denizli, Turkey
| | - Koray Tekin
- Department of General Surgery, Pamukkale University, Faculty of Medicine, Denizli, Turkey
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Palabiyikoglu I, Tekeli E, Cokca F, Akan O, Unal N, Erberktas I, Lale S, Kiraz S. Nosocomial meningitis in a university hospital between 1993 and 2002. J Hosp Infect 2006; 62:94-7. [PMID: 16290316 DOI: 10.1016/j.jhin.2005.06.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2004] [Accepted: 06/03/2005] [Indexed: 11/28/2022]
Abstract
The aim of this study was to establish the relationship between nosocomial meningitis (NM) and surgical interventions, type of pathogens and other hospital infections (HIs). Fifty-one patients diagnosed with NM, according to the criteria of the Centers for Disease Control and Prevention, in the Neurosurgery Department of Ibn-i Sina Hospital of Ankara University between 1993 and 2002 were evaluated retrospectively. All individuals with NM were hospitalized in the intensive care unit. Third-generation cephalosporins were used for surgical prophylaxis and broad-spectrum antibiotics were used for treatment. NM occurred in 0.34% of all admissions and accounted for 0.53% of all HIs. Fourteen cases (28%) had at least one concurrent HI, mainly originating from surgical wounds and related secondary bacteraemia. Four cases had NM following surgical site infection with the same causative agent and three cases had bacteraemia. All the individuals had surgical interventions and 26 (51%) had operations concerning ventriculoperitoneal shunt. A positive microbiological cause was found in the cerebrospinal fluid of 49 patients, with 16 cases having a polymicrobial cause. Of all 67 micro-organisms isolated, 41 (61%) were Gram-negative bacilli, 23 (34%) were Gram-positive cocci and the remaining three (5%) were Candida spp. Staphylococci were the most common pathogens (30%), followed by non-fermentative Gram-negative bacilli (22%).
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Affiliation(s)
- I Palabiyikoglu
- Infection Control Committee, Medical Faculty of Ankara University, 06 100 Samanpazari/Ankara, Turkey.
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Abstract
Management of device-related infections includes device removal for some catheter-related bloodstream infections and all ventriculoperitoneal shunt-related infections. The isolation of certain organisms (eg, Staphylococcus aureus, Candida spp) in children with central catheters should prompt consideration of disseminated infection. Future research may determine the impact of increasing catheter use in non-intensive care hospital settings and in home care. New technologies, such as antimicrobial-impregnated central venous catheters and ventricular shunts, show promise in reducing the infection rates of these devices.
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Affiliation(s)
- Samir S Shah
- Division of Infectious Diseases, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, USA.
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Arda B, Yamazhan T, Sipahi OR, Islekel S, Buke C, Ulusoy S. Meningitis due to methicillin-resistant Staphylococcus aureus (MRSA): Review of 10 cases. Int J Antimicrob Agents 2005; 25:414-8. [PMID: 15848297 DOI: 10.1016/j.ijantimicag.2004.12.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2004] [Accepted: 12/17/2004] [Indexed: 11/25/2022]
Abstract
We evaluated retrospectively, 10 MRSA meningitis cases in our hospital that occurred between January 1999 and June 2004. All were post-neurosurgical and were considered to have hospital-acquired meningitis. Fever, leukocytosis, variable conscious levels were the most common findings. Six patients were treated with regimens including teicoplanin, and four with vancomycin. Mean duration of treatment was 23.5+/-18.8 days (range, 3-60 days). One patient died. In cases of MRSA meningitis, intravenous vancomycin is the mainstay of therapy. However, six of these 10 patients were successfully treated with regimens including teicoplanin, suggesting that this agent may be an alternative to vancomycin in the therapy of these cases.
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Affiliation(s)
- Bilgin Arda
- Ege University, Medical Faculty, Department of Infectious Diseases and Clinical Microbiology, 35100 Bornova, Izmir, Turkey.
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Haase MR. Acute Bacterial Meningitis in Children. J Pharm Pract 2004. [DOI: 10.1177/0897190004270422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Despite advances in recent decades in management, including new and effective antimicrobials, children with bacterial meningitis still incur significant morbidity and mortality. Pathophysiologic processes including colonization and migration of the bacteria to blood, seeding of the meninges, and meningeal and brain inflammation have been largely elucidated, but more specific knowledge could lead to new effective therapies. Outside of the neonatal period, the most common causative organisms have been Haemophilus influenzae, Streptococcus pneumoniae, and Neisseria meningitidis. However, conjugate vaccines, especially the H influenzae type b preparation, have contributed significantly to steep declines in the incidence of meningitis. Optimal management consists of rapid diagnosis and administration of bactericidal antibiotics with properties allowing adequate penetration of the inflamed blood-brain barrier. Recently, development of microbial resistance has resulted in changes to recommended empiric antibiotic regimens. Novel therapies are under investigation; however, until controlled trials can be conducted, these therapies cannot be recommended.
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Affiliation(s)
- Mark R. Haase
- Texas Tech University, HSC School of Pharmacy, 1300 S. Coulter, Suite 206, Amarillo, TX 79106-1712
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Abstract
The number of indwelling medical devices is escalating, and an increasing proportion of device-related infections are being caused by Candida spp. Candida spp. produce biofilms on synthetic materials, which facilitates adhesion of the organisms to devices and renders them relatively refractory to medical therapy. Management of device-related Candida infections can be challenging. Removal of the infected device is generally needed to establish cure of Candida infections of medical devices. However, since the pathogenesis of Candida bloodstream infection is complicated, more studies are necessary to determine the role of catheter exchange in patients with both gastrointestinal tract mucositis and indwelling catheters. The medical and economic impact of these infections is enormous.
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Affiliation(s)
- Erna M Kojic
- Medical Service, Infectious Disease Section, Veterans Affairs Medical Center, Baylor College of Medicine, Houston, Texas 77030, USA
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Cardona-Bonet LL, Cortes A. Management of perioperative infectious complications in the neurologic patient. Neurol Clin 2004; 22:329-45. [PMID: 15062515 DOI: 10.1016/j.ncl.2003.12.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Although most neurosurgeries are considered "sterile" procedures, anti-biotic prophylaxis is favored in the literature because of the potential for serious complications related to the central nervous system. There is a paucity of literature addressing the management of infectious complications related to neurostimulators and intraspinal/epidural catheters and pump; therefore, further studies are needed to develop standard protocols of care. Finally, perioperative complications in the patient undergoing a neuro-surgical procedure are similar to those undergoing any surgery, but have a higher potential for morbidity and mortality because of the central nervous system. The skill of the surgeon, care of the perioperative team, and knowledge of the neurologist remain the most important factors in the prevention, early recognition, and intervention of these complications.
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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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Pintado V, Cabellos C, Moreno S, Meseguer MA, Ayats J, Viladrich PF. Enterococcal meningitis: a clinical study of 39 cases and review of the literature. Medicine (Baltimore) 2003; 82:346-64. [PMID: 14530784 DOI: 10.1097/01.md.0000090402.56130.82] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
To describe the clinical features and outcome of enterococcal meningitis, we retrospectively reviewed the charts of 39 cases seen at 2 tertiary hospitals during a 25 years and collected 101 additional, previously reported cases for review. Among these 140 cases, there were 82 cases (59%) of postoperative meningitis and 58 cases (41%) of spontaneous meningitis. Eighty-six patients (61%) were adults and 54 (39%) were children. Patients with spontaneous meningitis had a higher frequency of community-acquired infection (50% versus 18%; p < 0.01), severe underlying diseases (67% versus 22%; p < 0.01), and associated enterococcal infection (29% versus 8%; p < 0.01) than patients with postoperative meningitis. The clinical presentation was similar in both groups, but patients with spontaneous infection had a higher frequency of bacteremia (58% versus 12%; p < 0.01), and a lower frequency of mixed infection (9% versus 29%; p < 0.01). Spontaneous meningitis in children was associated with a significantly lower frequency of fever, altered mental status, headache, and meningeal signs (p < 0.01), probably explained by the high proportion of neonates in this age-group. Most infections were caused by Enterococcus faecalis, which accounted for 76% of the isolates identified at the species level. Fifteen of the 25 cases due to Enterococcus faecium were produced by vancomycin-resistant strains. Most patients were treated with ampicillin, penicillin, or vancomycin, with or without aminoglycosides, for a median period of 18 days (range, 1-85 d). Overall mortality was 21%. The mortality rate was higher in spontaneous than in postoperative meningitis (33% versus 12%; p < 0.01), but was similar in patients treated with beta-lactams (18%), glycopeptides (14%), or other antibiotics (25%), as well as in patients treated with monotherapy (16%) or combination therapy (22%). An adverse outcome correlated significantly with advanced age, the presence of severe underlying diseases, associated enterococcal infection, bacteremia, septic shock, and the absence of fever at presentation. Shunt removal was associated with a lower mortality. Multivariate analysis showed that the presence of severe underlying diseases was the only prognostic factor associated with mortality (odds ratio = 6.8, 95% confidence intervals = 2.7-17.5, p < 0.01).
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Affiliation(s)
- Vicente Pintado
- Infectious Diseases Department, Hospital Ramón y Cajal, Carretera de Colmenar km 9.1, 28034 Madrid, Spain.
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Scribano PV, Pool S, Smally AJ. Comparison of ventriculoperitoneal shunt tap and lumbar puncture in a child with meningitis. Pediatr Emerg Care 2002; 18:E1-3. [PMID: 12187146 DOI: 10.1097/00006565-200208000-00001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Philip V Scribano
- Department of Pediatrics, University of Connecticut School of Medicine, Connecticut Children's Medical Center, Hartford, Connecticut, USA.
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Gill CJ, Murphy MA, Hamer DH. Treatment of Staphylococcus epidermidis ventriculo-peritoneal shunt infection with linezolid. J Infect 2002; 45:129-32. [PMID: 12217722 DOI: 10.1053/jinf.2002.0979] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Gram-positive bacterial meningitis frequently complicates ventriculo-peritoneal (VP) shunts used for hydrocephalus. Linezolid, an oxazolidinone, is active against Gram-positive cocci, and has excellent CSF penetration. We present a 22-year-old woman who was cured of a Staphylococcus epidermidis VP shunt infection via shunt removal and intravenous linezolid.
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Affiliation(s)
- C J Gill
- Division of Geographic Medicine and Infectious Diseases, New England Medical Center, Boston, MA 02111, USA
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Huang CR, Lu CH, Chien CC, Chang WN. Protean infectious types and frequent association with neurosurgical procedures in adult Serratia marcescens CNS infections: report of two cases and review of the literature. Clin Neurol Neurosurg 2001; 103:171-4. [PMID: 11532558 DOI: 10.1016/s0303-8467(01)00138-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Serratia marcescens is a rare pathogen of adult central nervous system (CNS) infection. We report on the clinical features and therapeutic outcomes of two adult patients with such infections. The clinical characteristics of 13 other reported adult cases are also included for analysis. The 15 cases were nine males and six females, aged 19-83 years, in whom, underlying post-neurosurgical states and ear operation were noted in 93% (14/15). Fever and conscious disturbance were the most common clinical manifestations of these 15 cases, followed by hydrocephalus, seizures, and wound infections. The manifestation types were protean, including meningitis and focal suppurations such as brain abscess, cranial and spinal epidural abscess, cranial subdural abscess, and infected lumbar pseudomeningocele. One case of S. marcescens CNS infection was diagnosed postmortem; the other 14 were diagnosed by the positive culture from CSF or pus. Antibiotic therapy with or without neurosurgical intervention was the management strategy in 14/15 cases. The therapeutic results showed a high mortality rate.
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Affiliation(s)
- C R Huang
- Department of Neurology, Chang Gung Memorial Hospital-Kaohsiung, 123, Ta Pei Road, Niao Sung Hsiang, Hsien, Kaohsiung, Taiwan, ROC
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Balogun RA, Palmisano J, Kaplan AA, Khurshid H, Yamase H, Adams ND. Shunt nephritis from Propionibacterium acnes in a solitary kidney. Am J Kidney Dis 2001; 38:E18. [PMID: 11576905 DOI: 10.1053/ajkd.2001.27726] [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: 02/04/2023]
Abstract
Since its initial description in 1965, immune complex glomerulonephritis associated with ventriculoatrial shunts (VAS) has been reported widely in the literature. The most common incriminating organism is Staphylococcus epidermidis, but less often, an organism generally regarded as nonpathogenic, such as Propionibacterium acnes, has been noted as the cause. Shunt infection usually occurs within a few months after placement or manipulation of the shunt, and shunt nephritis (SN) develops gradually over months to years after. Treatment involves mandatory removal of the shunt and antibiotics; prognosis is variable. We report a case of SN with P acnes that is unusual because of its occurrence in a solitary kidney 6 years after shunt placement, persistently negative blood cultures, and normal complement levels. Percutaneous biopsy of a solitary kidney should be considered if it is expected that the result may guide therapy of progressive renal failure.
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Affiliation(s)
- R A Balogun
- Nephrology Division, Department of Medicine, University of Connecticut Health Center, Farmington, CT 06030, USA.
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Brackbill ML, Brophy GM. Adjunctive rifampin therapy for central nervous system staphylococcal infections. Ann Pharmacother 2001; 35:765-9. [PMID: 11408996 DOI: 10.1345/aph.10224] [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: 11/27/2022] Open
Abstract
OBJECTIVE To review the published clinical data assessing the role of adjunctive rifampin therapy for the treatment of staphylococcal central nervous system (CNS) infections. DATA SOURCES A MEDLINE search (January 1966-March 2000) of English-language literature pertaining to CNS staphylococcal infections and rifampin was performed; tertiary sources were also used. DATA EXTRACTION Human data and case reports were included, as no clinical trials have been published. DATA SYNTHESIS Retrospective reviews of rifampin used in combination with other antibiotics for serious bacterial infections show conflicting results. Few case reports have described clinical successes with adjunctive rifampin therapy for CNS infections. CONCLUSIONS The routine use of adjunctive rifampin for CNS infections cannot be justified.
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Affiliation(s)
- M L Brackbill
- Virginia Commonwealth University/Medical College of Virginia Campus, Richmond, VA, USA
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