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Aslam Khan A, Anwar MS, Cherukuri PB, Abu-Shanab A, Fish PN. Community-Acquired Meningitis Complicated With Pyogenic Ventriculitis and Hydrocephalus in a Patient With Haematological Malignancy: A Case Report and Literature Review. Cureus 2024; 16:e60800. [PMID: 38903366 PMCID: PMC11188013 DOI: 10.7759/cureus.60800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2024] [Indexed: 06/22/2024] Open
Abstract
Meningitis, an infection of the meninges of the central nervous system (CNS), can advance quickly and carries a mortality rate reaching 30% among affected patients. It may become complicated by conditions such as hydrocephalus, ventriculitis, and cerebral abscess. Here, we describe a case of meningitis that was complicated by pyogenic ventriculitis and hydrocephalus in a patient with diffuse large B-cell lymphoma (DLBCL) who underwent chemotherapy and radiotherapy. The patient presented with acute change in mental status and high-grade fever, with few episodes of non-bloody vomiting. Blood culture and cerebrospinal fluid (CSF) culture grew Streptococcus pneumoniae, which was sensitive to ceftriaxone. CT scan of the head showed ventriculomegaly, pansinusitis, and a large left mastoid effusion. MRI of the brain showed layering in ventricles, hydrocephalus, and dural enhancement consistent with pachymeningitis. She was treated with ceftriaxone for 21 days with a meaningful outcome. She was discharged home with near-baseline mental capacity for further physical therapy.
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Affiliation(s)
- Anosh Aslam Khan
- Department of Internal Medicine, Monmouth Medical Center, Long Branch, USA
| | | | | | - Amer Abu-Shanab
- Department of Internal Medicine, Monmouth Medical Center, Long Branch, USA
| | - Peter N Fish
- Department of Internal Medicine, Monmouth Medical Center, Long Branch, USA
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Rojas-Lora M, Corral L, Zabaleta-Carvajal I, López-Ojeda P, Fuentes-Mila V, Romera-Peregrina I, Lerma-Briansò C, Plata-Menchaca E, Pavón A, Sabater J, Cabellos C. External ventriculostomy-associated infection reduction after updating a care bundle. Ann Clin Microbiol Antimicrob 2023; 22:59. [PMID: 37454149 DOI: 10.1186/s12941-023-00612-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 07/07/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Despite the clinical benefits of external ventricular drains (EVD), these devices can lead to EVD-related infections (EVDRI). The drainage insertion technique and standardized guidelines can significantly reduce the risk of infection, mainly caused by gram-positive bacteria. However, gram-negative microorganisms are the most frequent causative microorganisms of EVDRI in our hospital. We aimed to determine whether a new bundle of measures for the insertion and maintenance of a drain could reduce the incidence of EVDRI. This cohort study of consecutive patients requiring EVD from 01/01/2015 to 12/31/2018 compared the patients' characteristics before and after introducing an updated protocol (UP) for EVD insertion and maintenance in 2017. RESULTS From 204 consecutive patients, 198 requiring EVD insertion were included (54% females, mean age 55 ± 15 years). The before-UP protocol included 87 patients, and the after-UP protocol included 111 patients. Subarachnoid (42%) and intracerebral (24%) hemorrhage were the main diagnoses at admission. The incidence of EVDRI fell from 13.4 to 2.5 episodes per 1000 days of catheter use. Gram-negative bacteria were the most frequent causative microorganisms. Previous craniotomy remained the only independent risk factor for EVDRI. EVDRI patients had increased mechanical ventilation durations, hospital and ICU stays, and percutaneous tracheostomy requirements. CONCLUSIONS A care bundle focusing on fewer catheter sampling and more accurate antiseptic measures can significantly decrease the incidence of EVDRI. After implementing the management protocol, a decreased incidence of infections caused by gram-negative and gram-positive bacteria and reduced ICU and hospital lengths of stay were observed.
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Affiliation(s)
- Mariel Rojas-Lora
- Intensive Care Department, Servei de Medicina Intensiva, IDIBELL-Hospital Universitari de Bellvitge, Feixa Llarga S/N, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
- Universitat de Barcelona, L'Hospitalet de Llobregat, Spain
| | - Luisa Corral
- Intensive Care Department, Servei de Medicina Intensiva, IDIBELL-Hospital Universitari de Bellvitge, Feixa Llarga S/N, L'Hospitalet de Llobregat, 08907, Barcelona, Spain.
- Departament de Ciències Clíniques, Universitat de Barcelona, Av. Mare de Déu de Bellvitge, 3, Feixa Llarga S/N, L'Hospitalet de Llobregat, 08907, Barcelona, Spain.
| | - Ivan Zabaleta-Carvajal
- Neurosurgery Department, IDIBELL-Hospital Universitari de Bellvitge, Feixa Llarga S/N, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
| | - Pau López-Ojeda
- Neurosurgery Department, IDIBELL-Hospital Universitari de Bellvitge, Feixa Llarga S/N, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
- Universitat de Barcelona, L'Hospitalet de Llobregat, Spain
| | - Verónica Fuentes-Mila
- Intensive Care Department, Servei de Medicina Intensiva, IDIBELL-Hospital Universitari de Bellvitge, Feixa Llarga S/N, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
| | - Iluminada Romera-Peregrina
- Intensive Care Department, Servei de Medicina Intensiva, IDIBELL-Hospital Universitari de Bellvitge, Feixa Llarga S/N, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
| | - Cristina Lerma-Briansò
- Intensive Care Department, Servei de Medicina Intensiva, IDIBELL-Hospital Universitari de Bellvitge, Feixa Llarga S/N, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
| | - Erika Plata-Menchaca
- Vall d'Hebron Research Institute, Passeig de La Vall d'Hebron, 129, 08035, Barcelona, Spain
- Universitat de Barcelona, L'Hospitalet de Llobregat, Spain
| | - Alba Pavón
- Departament de Ciències Clíniques, Universitat de Barcelona, Av. Mare de Déu de Bellvitge, 3, Feixa Llarga S/N, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
| | - Joan Sabater
- Intensive Care Department, Servei de Medicina Intensiva, IDIBELL-Hospital Universitari de Bellvitge, Feixa Llarga S/N, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
- Universitat de Barcelona, L'Hospitalet de Llobregat, Spain
| | - Carmen Cabellos
- Infectious Diseases Department, IDIBELL-Hospital Universitari de Bellvitge, Barcelona, Spain
- Departament de Ciències Clíniques, Universitat de Barcelona, Av. Mare de Déu de Bellvitge, 3, Feixa Llarga S/N, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
- Centro de Investigación Biomédica de Enfermedades Infecciosas (CIBERINFEC, ISCIII), Madrid, Spain
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Lim J, Maggs C, Athan E. Unusual stroke mimic: a rare case of Escherichia coli meningitis. Intern Med J 2021; 51:1969-1970. [PMID: 34796630 DOI: 10.1111/imj.15578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 04/20/2021] [Accepted: 04/29/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Julia Lim
- General Medicine, Barwon Health, Geelong, Victoria, Australia
| | - Callum Maggs
- Infectious Diseases, Barwon Health, Geelong, Victoria, Australia
| | - Eugene Athan
- Infectious Diseases, Barwon Health, Geelong, Victoria, Australia
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