Pseudomonas aeruginosa nosocomial meningitis following spinal anesthesia – still a significant treatment dilemma

BACKGROUND: Infections of central nervous system after spinal anesthesia nowadays are a rarity; however, their presence might be of concern. CASE DESCRIPTION: We report the case of lateral ventricular empyema treated unsuccessfully with parenteral antibiotic therapy, with the clinical signs of a persisting meningitis. After several lumbar taps suggesting an infection, Pseudomonas aeruginosa was isolated and a brain magnetic resonance imaging find out the collection in the left horn of the lateral ventricle. An intrathecal/intraventricular antibiotic therapy with colistin proved highly effective combined with an extra ventricular drainage to deal with the hydrocephaly. CONCLUSION: Clinicians should take into account even uncommon infectious agents while facing the picture of a meningitis otherwise nonresponsive to empiric or standard therapy.