Document Detail


Gram-negative bacillary meningitis after cranial surgery or trauma in adults.
MedLine Citation:
PMID:  15119359     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
In order to assess the clinical features, aetiology, treatment and outcome of post-neurosurgical and post-traumatic Gram-negative bacillary meningitis (GNBM) we performed a retrospective review of all adult patients admitted to the Department of Neurosurgery who had Gram-negative bacilli cultured from cerebrospinal fluid (CSF) following a neurosurgical procedure or traumatic head/spinal injury. During the 12 y of the review 33 patients had CSF isolates of Gram-negative bacilli that were thought to be significant. The median patient age was 47 y (range 22-77 y) and 21 (64%) were male. Klebsiella pneumoniae, Enterobacter cloacae and Escherichia coli were the most common isolates. Minimal inhibitory concentrations (MIC) measured for half the patients' isolates resulted in 5 regimen changes, including 2 patients with E. cloacae meningitis in whom cephalosporin susceptibility decreased during cephalosporin treatment. Our recommended initial treatment was intravenous ceftriaxone and amikacin, subsequently tailored by susceptibility results; approximately half the patients remained on the antibiotics they started and half were changed to an alternate regimen, most often a carbapenem. Five patients (15%) died, 1 dying after cure of his GNBM. There were no failures in those who received more than 12 d of appropriate treatment: treatment for at least 14 d after the last positive CSF culture guaranteed cure. Initial ceftriaxone and amikacin subsequently changing to susceptibility driven alternatives, often a carbapenem, resulted in cure of 85% of our patients with GNBM.
Authors:
Simon Briggs; Rod Ellis-Pegler; Nigel Raymond; Mark Thomas; Lucille Wilkinson
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Scandinavian journal of infectious diseases     Volume:  36     ISSN:  0036-5548     ISO Abbreviation:  Scand. J. Infect. Dis.     Publication Date:  2004  
Date Detail:
Created Date:  2004-05-03     Completed Date:  2004-06-08     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0215333     Medline TA:  Scand J Infect Dis     Country:  Sweden    
Other Details:
Languages:  eng     Pagination:  165-73     Citation Subset:  IM    
Affiliation:
Department of Infectious Diseases, Auckland Hospital, Auckland, New Zealand.
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MeSH Terms
Descriptor/Qualifier:
Adult
Age Distribution
Aged
Anti-Bacterial Agents*
Brain Injuries / complications
Drug Therapy, Combination / administration & dosage*
Female
Follow-Up Studies
Gram-Negative Bacteria / drug effects,  isolation & purification*
Gram-Negative Bacterial Infections / drug therapy*,  epidemiology,  etiology*
Humans
Incidence
Infusions, Intravenous
Male
Meningitis, Bacterial / drug therapy*,  epidemiology,  etiology*
Microbial Sensitivity Tests
Middle Aged
Neurosurgical Procedures / adverse effects
New Zealand / epidemiology
Retrospective Studies
Severity of Illness Index
Sex Distribution
Survival Analysis
Treatment Outcome
Chemical
Reg. No./Substance:
0/Anti-Bacterial Agents

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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