Enterococcal Meningitis/Ventriculitis: A Tertiary Care Experience

CONTEXT: Enterococcal meningitis is very rare among bacterial meningitis and has variable clinical outcomes. AIMS: The purpose of the current study is to evaluate clinical features, therapeutic options with susceptibility profile, and outcomes of enterococcal meningitis in a tertiary care hospital. SETTINGS AND DESIGN: We retrospectively reviewed medical records of all patients with enterococcal meningitis over the periods of 4 years. SUBJECTS AND METHODS: The clinical and laboratory data of all patients with enterococcal meningitis were evaluated between 2013 and 2016. RESULTS: Six cases of enterococcal meningitis were found (three infant and three adults). All patients developed meningitis after neurosurgical procedures, and majority of patients (four out of six) had central nervous system (CNS) devices in situ at the time of development of meningitis. The causative organism isolated from cerebrospinal fluid (CSF) culture of all patients was Enterococcus species only. All Enterococcus spp. were resistant to ampicillin, Amoxicillin-clavulanate, and oxytetracycline and two isolates were also resistant to vancomycin. Four patients with vancomycin-sensitive Enterococcus spp. were treated with vancomycin alone for mean periods of 18 days (14–21 days). One patient with vancomycin-resistant Enterococcus (VRE) meningitis was treated with linezolid alone, and another one requires combination with rifampicin to achieve microbiological clearance of CSF. CNS devices were removed in all patients. No mortality was reported in current case series. CONCLUSIONS: Enterococcal meningitis is very uncommon, mostly associated with neurosurgical intervention. Early treatment is associated with favorable outcomes. Removal of CNS devices is recommended to achieve a clinical cure.