Korean J Intern Med.  2012 Jun;27(2):171-179. 10.3904/kjim.2012.27.2.171.

The Causes and Treatment Outcomes of 91 Patients with Adult Nosocomial Meningitis

• Kim HI
• Kim SW
• Park GY
• Kwon EG
• Kim HH
• Jeong JY
• Chang HH
• Lee JM
• Kim NS

• KMID: 1776544
• DOI: http://doi.org/10.3904/kjim.2012.27.2.171

Abstract

BACKGROUND/AIMS
Frequent pathogens of nosocomial meningitis were investigated and the adequacy of empiric antibiotic therapy was assessed. Outcomes of nosocomial meningitis were also evaluated.
METHODS
Ninety-one patients, who were diagnosed and treated for nosocomial meningitis at a single tertiary hospital in Daegu, Korea for 10 years, were included. Medical record and electronic laboratory data on the causative pathogens, antibiotics used, and outcomes were retrospectively investigated.
RESULTS
Coagulase-negative Staphylococcus (40.9%) was the most common pathogen, followed by Acinetobacter (32.5%). Both were cultured as a single organism in cerebrospinal fluid (CSF). Seventy-eight patients (85.7%) had infections related to external ventricular drains (EVD). The most common empirical antibiotics were extended-spectrum beta-lactam antibiotics plus vancomycin (35/91, 38.6%). Of the 27 patients who had cultured Acinetobacter in CSF, 10 (37%) were given the wrong empirical antibiotic treatment. Seven of the 27 patients (26.9%) with cultured Acinetobacter died, and overall mortality of the 91 patients was 16.5%. In the multivariate analysis, the presence of combined septic shock (p < 0.001) and a persistent EVD state (p = 0.021) were associated with a poor prognosis.
CONCLUSIONS
Acinetobacter is one of the leading pathogens of nosocomial meningitis and may lead to inadequate coverage of empiric antibiotic therapy due to increasing resistance. An EVD should be removed early in cases of suspected nosocomial meningitis, and carbapenem might be required for the poor treatment response.

Keyword

Meningitis; Acinetobacter; Drug resistance; Prognosis

MeSH Terms

Acinetobacter/classification/*isolation & purification
Acinetobacter Infections/cerebrospinal fluid/diagnosis/*drug therapy/*microbiology
Adult
Aged
Aged, 80 and over
Anti-Bacterial Agents/*therapeutic use
Cerebrospinal Fluid/microbiology
Cross Infection/cerebrospinal fluid/diagnosis/*microbiology/mortality/*therapy
Drug Resistance, Bacterial
Female
Humans
Logistic Models
Male
Meningitis, Bacterial/cerebrospinal fluid/diagnosis/*drug therapy/*microbiology/mortality
Middle Aged
Multivariate Analysis
Odds Ratio
Republic of Korea
Retrospective Studies
Risk Assessment
Risk Factors
Staphylococcal Infections/cerebrospinal fluid/diagnosis/*drug therapy/*microbiology/mortality
Staphylococcus/classification/*isolation & purification
Time Factors
Treatment Outcome
Young Adult