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Muller AE, van Vliet P, Koch BCP. Clinical Experience with Off-Label Intrathecal Administration of Selected Antibiotics in Adults: An Overview with Pharmacometric Considerations. Antibiotics (Basel) 2023; 12:1291. [PMID: 37627711 PMCID: PMC10451962 DOI: 10.3390/antibiotics12081291] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 07/30/2023] [Accepted: 08/03/2023] [Indexed: 08/27/2023] Open
Abstract
Drain-associated intracerebral infections are life-threatening emergencies. Their treatment is challenging due to the limited penetration of antibiotics to the site of infection, resulting in potentially inadequate exposure. The emergence of multidrug-resistant pathogens might force the use of off-label intrathecal (IT) doses of antibiotics. We reviewed the literature on general aspects determining intrathecal dosing regimen, using pharmacometric knowledge. We summarised clinical experience with IT doses of antibiotics that are usually not used intrathecally, as well as the outcome of the cases and concentrations reached in the cerebrospinal fluid (CSF). Factors determining the IT regimen are the size of the ventricle system and the CSF drainage volume. With regard to pharmacometrics, pharmacokinetic/pharmacodynamic indices are likely similar to those in non-cerebral infections. The following number (N) of cases were described: benzylpenicillin (>50), ampicillin (1), ceftazidime (2), cephaloridine (56), ceftriaxone (1), cefotiam (1), meropenem (57), linezolid (1), tigecycline (15), rifampicin (3), levofloxacin (2), chloramphenicol (3) and daptomycin (8). Many side effects were reported for benzylpenicillin in the 1940-50s, but for the other antibiotics, when administered correctly, all side effects were minor and reversible. These data might help when choosing an IT dosing regimen in case there is no alternative option due to antimicrobial resistance.
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Affiliation(s)
- Anouk E. Muller
- Department of Medical Microbiology, Haaglanden Medisch Centrum, 2512 VA The Hague, The Netherlands
- Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands
- Center for Antimicrobial Treatment Optimization Rotterdam (CATOR), 3015 GD Rotterdam, The Netherlands;
| | - Peter van Vliet
- Department of Intensive Care Medicine, Haaglanden Medisch Centrum, 2512 VA The Hague, The Netherlands;
| | - Birgit C. P. Koch
- Center for Antimicrobial Treatment Optimization Rotterdam (CATOR), 3015 GD Rotterdam, The Netherlands;
- Department of Hospital Pharmacy, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands
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Gogia B, Young AL, O'Brien BJ, Okhuysen PC, Kumar VA. Bihemispheric Cortical Infarcts in an Adult Secondary to Escherichia coli K1 Meningitis. Case Rep Neurol 2021; 13:572-577. [PMID: 34720964 PMCID: PMC8460961 DOI: 10.1159/000518312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 07/01/2021] [Indexed: 11/19/2022] Open
Abstract
Cerebral ischemia is a known complication of meningitis. Most Escherichia coli meningitis-induced infarcts have been reported in the neonatal and pediatric population. To the best of our knowledge, there have been no previous reports describing bilateral cortical infarcts in an adult secondary to a K1 strain of E. coli meningitis, and herein we report a case in a 25-year-old female. The challenge in treating this patient was determining the duration of systemic antibiotic treatment and whether or not to use steroids. This study demonstrates the necessity of early diagnosis and treatment of E. coli meningitis to prevent neurological complications, including stroke.
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Affiliation(s)
- Bhanu Gogia
- Department of Neurology, University of Texas Medical Branch, Galveston, Texas, USA
| | - Angela L Young
- Department of Neuroradiology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Barbara J O'Brien
- Department of Neuro-Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Pablo C Okhuysen
- Department of Infectious Diseases, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Vinodh A Kumar
- Department of Neuroradiology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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3
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Abstract
BACKGROUND Gram-negative bacillary meningitis (GNBM) is a rare disease with a high rate of mortality. OBJECTIVES The aim of this study was to describe the clinical presentation and outcome of primary and secondary GNBM and to evaluate the efficacy of ceftriaxone (a third-generation cephalosporin) in the treatment of this disease. MATERIALS AND METHODS A retrospective study was conducted including 95 patients with GNBM admitted to the Abbassia and Imbaba fever hospitals' meningitis wards in Egypt during the period from 1993 to the end of the year 2009. Their cerebrospinal fluid samples were subjected to conventional bacteriological methods for isolation of the causative Gram-negative bacilli. Forty-nine patients had primary GNBM (no predisposing cause of meningitis was detected) and 46 patients had secondary GNBM (with a predisposing cause of meningitis). RESULTS Primary GNBM was characterized by an abrupt onset and was significantly associated with typical signs of meningeal irritation. The most common infecting organisms were Salmonella typhi in 16 (33%) patients and Escherichia coli in 15 (31%) patients. Of the patients with primary GNBM, 26 (53%) were cured, 11 (22%) developed neurological sequalae, and 12 (24%) patients died. Secondary GNBM was characterized by an insidious onset and significantly associated with unarousable coma. The most common infecting organisms were Proteus mirabilis in 17 (37%) patients and Pseudomonas aeruginosa in 16 (35%) patients. The most common predisposing factor of meningitis was otitis media and occurred in 26 (57%) patients. Of the patients with secondary GNBM, 15 (33%) were cured, 15 (33%) developed neurological sequalae, and 16 (35%) died. Primary GNBM was significantly associated with a higher cure rate than secondary GNBM. The duration of symptoms in patients with secondary GNBM was significantly higher than in those with primary GNBM. Ceftriaxone was the initial drug for treatment of these patients until the antibiotic sensitivity tests were reported. The overall resistance rate to the drug was 4%. CONCLUSION AND RECOMMENDATIONS GNBM still has a high mortality rate and should be managed as a medical emergency. GNBM should be suspected in patients with otitis media, neurosurgical, and head trauma or who underwent spinal anesthesia and have disturbance in their level of consciousness, even if there are no signs of meningeal irritation. Ceftriaxone is still an effective drug and had a low rate of resistance in our study.
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Kohlmann R, Nefedev A, Kaase M, Gatermann SG. Community-acquired adult Escherichia coli meningitis leading to diagnosis of unrecognized retropharyngeal abscess and cervical spondylodiscitis: a case report. BMC Infect Dis 2015; 15:567. [PMID: 26654107 PMCID: PMC4676899 DOI: 10.1186/s12879-015-1310-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 12/03/2015] [Indexed: 01/17/2023] Open
Abstract
Background Escherichia coli is a rare cause of community-acquired meningitis in adults unless predisposing factors are present (e.g., previous penetrating cranio-cerebral injury or neurosurgery, immunosuppression, chronic alcoholism, history of cancer, diabetes mellitus, advanced age). Case presentation We describe the case of a 53-year-old woman, resident in Germany, suffering from community-acquired bacterial meningitis caused by CTX-M-9 type extended spectrum β-lactamase producing Escherichia coli. Because typical predisposing factors were not apparent, pathogen identification resulted in expanded diagnostics to exclude a distant or contiguous primary focus. By magnetic resonance tomography, a previously unrecognized large retropharyngeal abscess with cervical spondylodiscitis was detected. In retrospect, the patient had complained about neck pain for a few weeks prior to meningitis onset, but the symptoms were interpreted as being related to a herniated disk. Meningitis and osteomyelitis resolved completely under surgical treatment and meropenem therapy. Conclusion In case of adult Escherichia coli meningitis, underlying diseases should always be carefully excluded, especially if predisposing factors are not apparent.
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Affiliation(s)
- Rebekka Kohlmann
- Department of Medical Microbiology, Ruhr-University Bochum, Universitaetsstrasse 150, 44801, Bochum, Germany. .,Institute of Medical Laboratory Diagnostics (IML) Bochum GmbH, Castroper Strasse 45, 44791, Bochum, Germany.
| | - Andrey Nefedev
- Department of Neurology, Evangelisches Krankenhaus Castrop-Rauxel, Grutholzallee 21, 44577, Castrop-Rauxel, Germany.
| | - Martin Kaase
- Department of Medical Microbiology, Ruhr-University Bochum, Universitaetsstrasse 150, 44801, Bochum, Germany.
| | - Sören G Gatermann
- Department of Medical Microbiology, Ruhr-University Bochum, Universitaetsstrasse 150, 44801, Bochum, Germany. .,Institute of Medical Laboratory Diagnostics (IML) Bochum GmbH, Castroper Strasse 45, 44791, Bochum, Germany.
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Poetker DM, Edmiston CE, Smith MM, Meyer GA, Wackym PA. Meningitis Due to Enterobacter aerogenes Subsequent to Resection of Acoustic Neuroma and Percutaneous Endoscopic Gastrostomy Tube Placement: A Rare Nosocomial Event. Infect Control Hosp Epidemiol 2015; 24:780-2. [PMID: 14587946 DOI: 10.1086/502135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AbstractWe present a case of meningitis after percutaneous endoscopic gastrostomy (PEG) tube placement subsequent to acoustic neuroma resection and cranioplasty. Four days following PEG tube placement the patient developed Enterobacter aerogenes meningitis, requiring explantation of infected cranioplasty material. His condition subsequently improved. Etiology and future intervention strategies are discussed (Infect Control Hosp Epidemiol 2003;24:780-782).
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Affiliation(s)
- David M Poetker
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee 53226, USA
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Pomar V, Benito N, López-Contreras J, Coll P, Gurguí M, Domingo P. Spontaneous gram-negative bacillary meningitis in adult patients: characteristics and outcome. BMC Infect Dis 2013; 13:451. [PMID: 24079517 PMCID: PMC3849584 DOI: 10.1186/1471-2334-13-451] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 09/24/2013] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Spontaneous meningitis caused by gram-negative bacilli in adult patients is uncommon and poorly characterized. Our objective is to describe and compare the characteristics and the outcome of adult patients with spontaneous gram-negative bacilli meningitis (GNBM) and spontaneous meningitis due to other pathogens. METHODS Prospective single hospital-based observational cohort study conducted between 1982 and 2006 in a university tertiary hospital in Barcelona (Spain). The Main Outcome Measure: In-hospital mortality. RESULTS Gram-negative bacilli meningitis was diagnosed in 40 (7%) of 544 episodes of spontaneous acute bacterial meningitis. The most common pathogens were Escherichia coli and Pseudomonas species. On admission, characteristics associated with spontaneous gram-negative bacilli meningitis by multivariate modeling were advanced age, history of cancer, nosocomial acquisition of infection, urinary tract infection as distant focus of infection, absence of rash, hypotension, and a high cerebrospinal fluid white-cell count. Nine (23%) episodes were acquired in the hospital and they were most commonly caused by Pseudomonas. The in-hospital mortality rate was 53%. The mortality rate was higher among patients with Gram-negative bacillary meningitis than among those with other bacterial meningitis and their risk of death was twenty times higher than among patients infected with Neisseria meningitidis (odds ratio 20.47; 95% confidence interval 4.03-103.93; p<0.001). CONCLUSIONS Gram-negative bacilli cause 9% of spontaneous bacterial meningitis of known etiology in adults. Characteristics associated with GNBM include advanced age, history of cancer, nosocomial acquisition, and urinary tract infection as distant focus of infection. The mortality rate is higher among patients with gram-negative bacillary meningitis than among those with other bacterial meningitides.
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Affiliation(s)
- Virginia Pomar
- Department of Internal Medicine, Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona, Spanish Network for Research in Infectious Diseases (REIPI), C/ Mas Casanovas 90, Barcelona 08025, Catalonia, Spain
| | - Natividad Benito
- Department of Internal Medicine, Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona, Spanish Network for Research in Infectious Diseases (REIPI), C/ Mas Casanovas 90, Barcelona 08025, Catalonia, Spain
| | - Joaquin López-Contreras
- Department of Internal Medicine, Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona, Spanish Network for Research in Infectious Diseases (REIPI), C/ Mas Casanovas 90, Barcelona 08025, Catalonia, Spain
| | - Pere Coll
- Department of Clinical Microbiology, Hospital de la Santa Creu i Sant Pau. Institut d'Investigació Biomèdica Sant Pau. Universitat Autònoma de Barcelona. Spanish Network for Research in Infectious Diseases (REIPI)., Barcelona, Spain
| | - Mercedes Gurguí
- Department of Internal Medicine, Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona, Spanish Network for Research in Infectious Diseases (REIPI), C/ Mas Casanovas 90, Barcelona 08025, Catalonia, Spain
| | - Pere Domingo
- Department of Internal Medicine, Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona, Spanish Network for Research in Infectious Diseases (REIPI), C/ Mas Casanovas 90, Barcelona 08025, Catalonia, Spain
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Briongos-Figuero LS, Morchón-Simón D, Aparicio-Blanco M, Garea García-Malvar MJ. [Spontaneous meningitis due to Escherichia coli in the adult: a case report]. Rev Clin Esp 2008; 208:262. [PMID: 18457644 DOI: 10.1157/13119924] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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8
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Bouadma L, Schortgen F, Thomas R, Wutke S, Lellouche F, Régnier B, Wolff M. Adults with spontaneous aerobic Gram-negative bacillary meningitis admitted to the intensive care unit. Clin Microbiol Infect 2006; 12:287-90. [PMID: 16451418 DOI: 10.1111/j.1469-0691.2005.01346.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The characteristics of spontaneous aerobic Gram-negative bacillary meningitis (AGNBM) were determined in 40 adults requiring admission to an intensive care unit (ICU) during a 16-year period in ten French ICUs. Eight infections were hospital-acquired and most patients had predisposing factors, mainly chronic alcoholism and an immunocompromised status. Three immunosuppressed patients had disseminated strongyloidiasis. Gram's stain, cerebrospinal fluid and blood cultures were positive for 85%, 98% and 80% of cases, respectively. Escherichia coli (57%) and Klebsiella pneumoniae (17%) were the most frequent pathogens. In-ICU mortality was 38%. Spontaneous AGNBM is a rare complication of bacteraemia in adults. The severity of predisposing underlying diseases might explain the poor prognosis despite appropriate antimicrobial therapy.
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Affiliation(s)
- L Bouadma
- Service de Réanimation Médicale et des Maladies Infectieuses, Hôpital Bichat-Claude-Bernard, Paris.
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9
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Bachmeyer C, Logak M, Ammouri W, Blanc AS. Spontaneous Escherichia coli meningitis with subdural empyema in an adult. South Med J 2006; 98:1225-6. [PMID: 16440928 DOI: 10.1097/01.smj.0000189909.51721.45] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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10
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Mofredj A, Guerin JM, Leibinger F, Mamoudi R. Spontaneous Escherichia coli meningitis in an adult. SCANDINAVIAN JOURNAL OF INFECTIOUS DISEASES 2002; 32:699-700. [PMID: 11200386 DOI: 10.1080/003655400459676] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Spontaneous meningitis due to gram-negative bacilli (excluding Hemophilus influenzae) is an infrequent infection in adult patients. It usually occurs in patients with underlying immunosuppressive conditions. Most of the cases are due to Escherichia coli and represent a complication of bacteraemia. The infection has a high mortality rate which may be as high as 90%, especially if associated with septicaemia. We report the case of a 53-y-old man with spontaneous, community-acquired Escherichia coli meningitis who was admitted with an unusual presentation. Blood and urine cultures were negative.
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Affiliation(s)
- A Mofredj
- Service de Reanimation, H pital Laënnec, Creil, France
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11
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Abstract
Central nervous system (CNS) infections are diverse. CNS infections can cause significant morbidity and mortality and are markedly different from systemic infections. The closed anatomic space of the CNS, its immunologic isolation from the rest of the body, and the often nonspecific nature of the key manifestations present a challenge to the clinician. Early recognition and aggressive management are essential to patient recovery and prevention of long-term neurologic sequelae. This review discusses the major types of CNS infections and focuses on critical care management, with emphasis on current epidemiologic trends.
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Affiliation(s)
- W C Ziai
- Neurosciences Critical Care Division, Johns Hopkins Hospital, Meyer 8-140, 600 N. Wolfe Street, Baltimore, MD 21287, USA
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12
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Harder E, Møller K, Skinhøj P. Enterobacteriaceae meningitis in adults: a review of 20 consecutive cases 1977-97. SCANDINAVIAN JOURNAL OF INFECTIOUS DISEASES 1999; 31:287-91. [PMID: 10482059 DOI: 10.1080/00365549950163590] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Enterobacteriaceae are not a frequent cause of meningitis in adults and are seen mainly in neurosurgical patients and on occasion in elderly and debilitated patients. Consequently, most series studied have been small and selected. In order to obtain a clearer clinical picture, we reviewed 20 consecutive cases of Enterobacteriaceae meningitis admitted to the Department of Infectious Diseases, Rigshospitalet, Copenhagen, during the years 1977-97. They comprised 1.5% of all cases of acute bacterial meningitis admitted to the department. All of the patients were either elderly and/or had 1 or more underlying diseases and predisposing factors. The clinical presentation and cerebrospinal fluid findings were not different from that of acute bacterial meningitis in general. The mortality rate was 40% and correlated with simultaneous bacteraemia. Complications were seen in a further 30% of patients and 25% survived with different sequelae. These high rates may, at least in part, be due to the advanced age and debilitated state of the patients studied. Escherichia coli was the most frequent of the Enterobacteriaceae.
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Affiliation(s)
- E Harder
- Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
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Abstract
BACKGROUND Although bacterial infections are frequent in patients with liver cirrhosis, only isolated cases of bacterial meningitis have been reported. METHODS We have reviewed a series of 16 cases of bacterial meningitis in patients with cirrhosis, diagnosed in a single hospital over a 30-year period. RESULTS Thirteen patients had alcoholic cirrhosis. On presentation, all patients had fever and most of them had an abnormal mental status (coma in 11 cases), but neck stiffness was not present or was delayed for more than 24 h in seven (43.7%) patients. The cerebrospinal fluid white cell count was always elevated, higher than 1000/microl in ten cases. The cerebrospinal fluid culture was positive in 14 (87.5%) patients. Gram-negative bacilli (mainly E. coli) and L. monocytogenes were the most frequent pathogens, accounting for nine cases. In contrast, S. pneumoniae and N. meningitidis were found in only four cases. Concurrent bacteremia was present in 12 (75%) cases. Ten patients (62.5%) died. Death was meningitis-related in seven patients and due to decompensated liver cirrhosis after clinical recovery from meningitis in the three other patients. Child-Pugh class C was associated with a higher mortality rate (80%, versus 33% for Child-Pugh class A-B), although the difference did not reach statistical significance. CONCLUSIONS Bacterial meningitis should be suspected in every patient with cirrhosis presenting with a febrile coma. If lumbar puncture must be delayed, or if no causative agent can be identified on cerebrospinal Gram stain despite elevated cerebrospinal fluid white cell count, empirical antimicrobial therapy should be started straightaway with ampicillin plus a third-generation cephalosporin in sufficient doses.
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Affiliation(s)
- A Pauwels
- Service d'Hépato-Gastroentérologie, Hôpital Saint-Antoine, Paris, France
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Peeters A, Vandercam B, Sindic CJ, Hantson P, Mahieu P. Community-acquired Serratia marcescens meningitis. J Infect 1997; 35:303-4. [PMID: 9459408 DOI: 10.1016/s0163-4453(97)93384-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Serratia marcescens is an unusual cause of community-acquired meningitis in adults. We report a case of S. marcescens meningitis occurring 29 years after a head injury and preceded by 3 years of intermittent nasal discharge of cerebrospinal fluid (CSF). One month before admission, the patient had received treatment with cefadroxil. This case illustrates the risk of Gram-negative bacillary meningitis in patients with a CSF leak when they are treated with antibiotics. When patients have a chronic clear nasal discharge, one should look for a past medical history of head injury before prescribing antibiotics. In the presence of a fistula, any antibiotherapy may lead to the selection of resistant organisms which may be difficult to treat. Due to the high risk of meningitis and the fact that spontaneous closure in delayed CSF rhinorrhoea is unlikely, surgical repair of any associated fistulae is mandatory.
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Affiliation(s)
- A Peeters
- Department of Neurology, St-Luc University Hospital, Brussels, Belgium
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15
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Fotopoulos TN, Greene JN, Sandin RL, Vincent AL. Successful Therapy of Postneurosurgical Meningitis Caused by a Resistant Strain of Enterobacter Aerogenes. Cancer Control 1997; 4:270-273. [PMID: 10763027 DOI: 10.1177/107327489700400311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- TN Fotopoulos
- Department of Internal Medicine, College of Medicine, Health Sciences Center, University of South Florida, Tampa 33612, USA
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Unhanand M, Mustafa MM, McCracken GH, Nelson JD. Gram-negative enteric bacillary meningitis: a twenty-one-year experience. J Pediatr 1993; 122:15-21. [PMID: 8419603 DOI: 10.1016/s0022-3476(05)83480-8] [Citation(s) in RCA: 126] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
We reviewed our experience with gram-negative enteric bacillary meningitis in neonates and infants from 1969 through 1989. Ninety-eight patients were identified. Their ages were from 1 day to 2 years with a median of 10 days. In 25 patients (26%), predisposing factors were identified, the most common of which were neural tube defects and urinary tract anomalies. The causative agents were Escherichia coli (53%), Klebsiella-Enterobacter species (16%), Citrobacter diversus (9%), Salmonella species (9%), Proteus mirabilis (4%), Serratia marcescens (3%), Bacteroides fragilis (3%), and Aeromonas species (2%). At the time of diagnosis, Gram-stained smears of cerebrospinal fluid revealed gram-negative bacilli in 61% of patients. The causative organism was cultured from blood obtained from 55% of patients, and 21% had positive urine culture results. The cerebrospinal fluid leukocyte counts ranged from 0 to 80,600 cells/mm3, and the cerebrospinal fluid/serum glucose concentration ratio was less than 0.5 in 72% of patients. Antimicrobial regimens varied greatly. After initiation of antibiotic therapy, an average of 3 days was needed for eradication of bacteria from cerebrospinal fluid. The case-fatality rate was 17%, and 61% of survivors had long-term sequelae that included seizure disorders, hydrocephalus, physical disability, developmental delay, and hearing loss.
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Affiliation(s)
- M Unhanand
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas
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