Clinical Features of Post-Operative Nosocomial Meningitis in Adults and Evaluation of Efficiency of Intrathecal Treatment
Surgical Infections, cilt.22, sa.10, ss.1059-1063, 2021 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 22 Sayı: 10
- Basım Tarihi: 2021
- Doi Numarası: 10.1089/sur.2021.024
- Dergi Adı: Surgical Infections
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, Academic Search Premier, CAB Abstracts, CINAHL, EMBASE, MEDLINE, Veterinary Science Database
- Sayfa Sayıları: ss.1059-1063
- Anahtar Kelimeler: intrathecal, meningitis, nosocomial, post-operative, treatment
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
Background: Post-operative nosocomial meningitis is a critical complication that develops in patients after neurosurgical interventions and operations. Patients and Methods: Data were collected for 65 patients who were diagnosed as having nosocomial meningitis after neurosurgery. The agent profile, clinical and biochemical differences in gram-negative and gram-positive meningitis, and the effectiveness of intrathecal antibiotic administration in cases with carbapenem-resistant gram-negative agents were evaluated. Results: Gram-negative bacteria were isolated in 52.3% of patients. In gram-negative cases of post-operative nosocomial meningitis, white blood cell count (p = 0.015), C-reactive protein (p = 0.001), cerebrospinal fluid leukocyte count (p = 0.0001), and protein (p = 0.0001) were higher, and glucose (p = 0.002) was lower. Concurrent bacteremia (p = 0.041), 14-day mortality (p = 0.022), and 30-day mortality (p = 0.023) were higher in gram-negative cases. Empirical treatment was appropriate in 78.5% of the patients. Seventeen patients (26.2%) received intrathecal antibiotic agents in addition to intravenous antibiotic treatment because of carbapenem-resistant gram-negative bacteria. Nine (53%) of the patients receiving intrathecal therapy had Acinetobacter baumannii as the agent, six had Klebsiella pneumoniae (35.4%), one had Pseudomonas aeruginosa (5.8%), and one had Providencia rettgeri (5.8%). The mean intravenous treatment duration was 21.4 ± 10.6 (4-60) days, and the mean intrathecal treatment duration was 17.6 ± 14.0 (1-51) days. Eleven patients received colistimethate sodium intrathecally (1 × 10 mg/d), three patients received amikacin intrathecally (1 × 10 mg/d), and three patients received gentamicin intrathecally (1 × 10 mg/d). Clinical and microbiologic treatment success was achieved in nine patients (53%). Conclusions: In cases of meningitis caused by carbapenem-resistant agents, intrathecal administration of antibiotic agents such as gentamicin, amikacin, and colistin with limited blood-brain barrier transition in intravenous administration will increase survival. Therefore, intrathecal antibiotic administration should be considered as a part of routine of nosocomial meningitis.