Bilateral Chronic Subdural Hematoma Contaminated with Klebsiella Pneumoniae : An Unusual Case

Abstract

J Korean Neurosurg Soc 45 : [397][398][399][400] 2009 This article presents the case of a bilateral chronic subdural hematoma which was contaminated with Klebsiella pneumoniae and resulted in a life-threatening central nervous system infection. After repeated of bilateral burr-hole drainage, the patient became hyperpyrexic and drowsy. Suppuration within the subdural space was suspected and then the patient underwent bilateral fronto-temporo-parietal craniotomies, and pus was evacuated. Its cultures revealed Klebsiella pneumoniae. Intravenous meropenem was given for 6 weeks. He recovered completely. Microorganisms like Klebsiella pneumoniae may directly infect the subdural space with iatrogenic contamination.

Subdural empyema complicated after trepanation and drainage of chronic subdural hematoma

“…[2,8,9] The most common infectious pathogen is Streptococcus milleri group, which is followed by other pathogenic bacteria, including b-hemolytic Streptococcus, Staphylococcus aureus, Haemophilus influenzae, Streptococcus mutans, and Pseudomonas. Escherichia coli, [15] Propionibacterium acnes, [16] Campylobacter fetus [17] and Klebsiella, [9,18] which are more rarely observed pathogens. Overall, 20% to 30% of cases of subdural empyema are not caused by infection with a single bacteria.…”

“…Overall, 20% to 30% of cases of subdural empyema are not caused by infection with a single bacteria. [8,9,15,16,17,18] In this case, the patient was infected with Klebsiella, a gram-negative bacillus that generally occurs in immunocompromised hosts. [9] This patient had a 25-year history of diabetes, which is a high risk factor for infection.…”

Complications of Purulent Meningoencephalitis in Children

“…Из осложнений, требующих наблюдения нейрохирурга, наиболее важными являются гидроцефалия и развитие хронических субдуральных гематом. Нейроинфекция часто является причиной развития хронических субдуральных гематом [3,8,9,11], наиболее характерной в раннем детском возрасте [1]. В некоторых литературных источниках сообщается о «субдуральном выпоте», обнаруживаемом в 25-50% неонатальных менингитов, которые часто встречаются при инфекционном поражении, вызванном гемофильной палочкой [5].…”