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Clinical characteristics and therapeutic outcomes of nosocomial super-infection in adult bacterial meningitis

BACKGROUND: Super-infection in adult bacterial meningitis (ABM) is a condition wherein the cerebrospinal fluid (CSF) grows new pathogen(s) during the therapeutic course of meningitis. It is an uncommon but clinically important condition rarely examined in literature. METHODS: Twenty-seven episodes o...

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Autores principales: Huang, Chi-Ren, Chen, Shu-Fang, Lu, Cheng-Hsien, Chuang, Yao-Chung, Tsai, Nai-Wen, Chang, Chiung-Chih, Wang, Hung-Chen, Chien, Chun-Chih, Chang, Wen-Neng
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2011
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3118143/
https://www.ncbi.nlm.nih.gov/pubmed/21592372
http://dx.doi.org/10.1186/1471-2334-11-133
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author Huang, Chi-Ren
Chen, Shu-Fang
Lu, Cheng-Hsien
Chuang, Yao-Chung
Tsai, Nai-Wen
Chang, Chiung-Chih
Wang, Hung-Chen
Chien, Chun-Chih
Chang, Wen-Neng
author_facet Huang, Chi-Ren
Chen, Shu-Fang
Lu, Cheng-Hsien
Chuang, Yao-Chung
Tsai, Nai-Wen
Chang, Chiung-Chih
Wang, Hung-Chen
Chien, Chun-Chih
Chang, Wen-Neng
author_sort Huang, Chi-Ren
collection PubMed
description BACKGROUND: Super-infection in adult bacterial meningitis (ABM) is a condition wherein the cerebrospinal fluid (CSF) grows new pathogen(s) during the therapeutic course of meningitis. It is an uncommon but clinically important condition rarely examined in literature. METHODS: Twenty-seven episodes of super-infection states in 21 ABM patients collected in a 9.5-year study period (January 2001 to June 2010) were evaluated. The clinical characteristics, implicated pathogens, results of antimicrobial susceptibility tests, and therapeutic outcomes were analyzed. RESULTS: Twenty-one patients (13 men, 8 women) aged 25-73 years (median, 45 years) had post-neurosurgical state as the preceding event and nosocomial infection. The post-neurosurgical states included spontaneous intracranial hemorrhage (ICH) with craniectomy or craniotomy with extra-ventricular drainage (EVD) or ventriculo-peritoneal shunt (VPS) in 10 patients, traumatic ICH with craniectomy or craniotomy with EVD or VPS in 6 patients, hydrocephalus s/p VPS in 2 patients, and one patient each with cerebral infarct s/p craniectomy with EVD, meningeal metastasis s/p Omaya implant, and head injury. All 21 patients had EVD and/or VP shunt and/or Omaya implant during the whole course of ABM. Recurrent fever was the most common presentation and the implicated bacterial pathogens were protean, many of which were antibiotic resistant. Most patients required adjustment of antibiotics after the pathogens were identified but even with antimicrobial therapy, 33.3% (7/21) died. Morbidity was also high among survivors. CONCLUSIONS: Super-infection in ABM is usually seen in patients with preceding neurosurgical event, especially insertion of an external drainage device. Repeat CSF culture is mandatory for diagnostic confirmation because most of the implicated bacterial strains are non-susceptible to common antibiotics used. Unusual pathogens like anaerobic bacteria and fungi may also appear. Despite antimicrobial therapy, prognosis remains poor.
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spelling pubmed-31181432011-06-19 Clinical characteristics and therapeutic outcomes of nosocomial super-infection in adult bacterial meningitis Huang, Chi-Ren Chen, Shu-Fang Lu, Cheng-Hsien Chuang, Yao-Chung Tsai, Nai-Wen Chang, Chiung-Chih Wang, Hung-Chen Chien, Chun-Chih Chang, Wen-Neng BMC Infect Dis Research Article BACKGROUND: Super-infection in adult bacterial meningitis (ABM) is a condition wherein the cerebrospinal fluid (CSF) grows new pathogen(s) during the therapeutic course of meningitis. It is an uncommon but clinically important condition rarely examined in literature. METHODS: Twenty-seven episodes of super-infection states in 21 ABM patients collected in a 9.5-year study period (January 2001 to June 2010) were evaluated. The clinical characteristics, implicated pathogens, results of antimicrobial susceptibility tests, and therapeutic outcomes were analyzed. RESULTS: Twenty-one patients (13 men, 8 women) aged 25-73 years (median, 45 years) had post-neurosurgical state as the preceding event and nosocomial infection. The post-neurosurgical states included spontaneous intracranial hemorrhage (ICH) with craniectomy or craniotomy with extra-ventricular drainage (EVD) or ventriculo-peritoneal shunt (VPS) in 10 patients, traumatic ICH with craniectomy or craniotomy with EVD or VPS in 6 patients, hydrocephalus s/p VPS in 2 patients, and one patient each with cerebral infarct s/p craniectomy with EVD, meningeal metastasis s/p Omaya implant, and head injury. All 21 patients had EVD and/or VP shunt and/or Omaya implant during the whole course of ABM. Recurrent fever was the most common presentation and the implicated bacterial pathogens were protean, many of which were antibiotic resistant. Most patients required adjustment of antibiotics after the pathogens were identified but even with antimicrobial therapy, 33.3% (7/21) died. Morbidity was also high among survivors. CONCLUSIONS: Super-infection in ABM is usually seen in patients with preceding neurosurgical event, especially insertion of an external drainage device. Repeat CSF culture is mandatory for diagnostic confirmation because most of the implicated bacterial strains are non-susceptible to common antibiotics used. Unusual pathogens like anaerobic bacteria and fungi may also appear. Despite antimicrobial therapy, prognosis remains poor. BioMed Central 2011-05-18 /pmc/articles/PMC3118143/ /pubmed/21592372 http://dx.doi.org/10.1186/1471-2334-11-133 Text en Copyright ©2011 Huang et al; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Huang, Chi-Ren
Chen, Shu-Fang
Lu, Cheng-Hsien
Chuang, Yao-Chung
Tsai, Nai-Wen
Chang, Chiung-Chih
Wang, Hung-Chen
Chien, Chun-Chih
Chang, Wen-Neng
Clinical characteristics and therapeutic outcomes of nosocomial super-infection in adult bacterial meningitis
title Clinical characteristics and therapeutic outcomes of nosocomial super-infection in adult bacterial meningitis
title_full Clinical characteristics and therapeutic outcomes of nosocomial super-infection in adult bacterial meningitis
title_fullStr Clinical characteristics and therapeutic outcomes of nosocomial super-infection in adult bacterial meningitis
title_full_unstemmed Clinical characteristics and therapeutic outcomes of nosocomial super-infection in adult bacterial meningitis
title_short Clinical characteristics and therapeutic outcomes of nosocomial super-infection in adult bacterial meningitis
title_sort clinical characteristics and therapeutic outcomes of nosocomial super-infection in adult bacterial meningitis
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3118143/
https://www.ncbi.nlm.nih.gov/pubmed/21592372
http://dx.doi.org/10.1186/1471-2334-11-133
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