Clinical features and in vitro antimicrobial susceptibilities of community-acquired Klebsiella pneumoniae meningitis in Taiwan

Abstract

Twenty-seven adult patients were identified as having community-acquired Klebsiella pneumoniae meningitis. The K. pneumoniae isolates, collected from cerebrospinal fluid samples, were tested for in vitro antimicrobial susceptibilities. The prognostic factors of these 27 patients were also analysed. All of the third- and fourth-generation cephalosporins tested, as well as monobactam, carbapenem and ciprofloxacin, had good activities against the isolated K. pneumoniae strains. None of the clinical isolates was detected as being an extended-spectrum beta-lactamase-producing pathogen. Among the third- and fourth-generation cephalosporins, ceftizoxime, cefepime, ceftriaxone and cefotaxime had superior activities, with MIC90s about four- to eight-fold lower than those of ceftazidime and moxalactam. Mortality rates of patients classified by different antimicrobial agents were as follows: ceftazidime 38% (8/21) and cefepime 16.7% (1/6). The presence of septic shock and the initial level of consciousness at the start of appropriate antimicrobial therapy were the major determinants of survival and neurological outcomes in these 27 patients. Early diagnosis and choice of appropriate antibiotics according to antimicrobial susceptibilities may improve therapeutic outcomes.

Clinical characteristics of post-neurosurgical Klebsiella pneumoniae meningitis in adults and a clinical comparison to the spontaneous form in a Taiwanese population

“…The reported overall mortality rates of K. pneumoniae ABM in Taiwan are high, ranging from 33.3% to 48.5% but, in this study, the outcome difference between the two forms of K. pneumoniae ABM was not significant. 17,18,26 In conclusion, our study revealed that K. pneumoniae was the second most common Gram-negative pathogen causing post-neurosurgical ABM in Taiwan. When compared with the spontaneous form, the patients with post-neurosurgical K. pneumoniae ABM had a lower incidence of community-acquired infection, seizure and DM, but had a higher incidence of leukocytosis, hydrocephalus and CSF leak.…”

“…2,[17][18][19][23][24][25] In Taiwan, there is a high incidence (>50%) of DM as an underlying condition in patients with community-acquired K. pneumoniae ABM. 2,18,26 Klebsiella pneumoniae also accounts for 68% of the pathogens implicated in patients with community-acquired ABM and DM. 23 The strong association between spontaneous K. pneumoniae ABM and DM was not observed in our patients with post-neurosurgical K. pneumoniae ABM, where only 22% patients (2/9) had DM.…”

Dynamic Changes of Matrix Metalloproteinase-9 in Patients with Klebsiella pneumoniae Meningitis

“…Elevated levels of MMP-9 have been reported to contribute to blood-brain barrier and CSF-brain barrier damage, leading to neuroinflammatory processes and edema of the meninges [9,15,16,15,16,22]. In Taiwan, K. pneumoniae meningitis is one of the most common causative pathogens of communityacquired bacterial meningitis [3,8]. It has been known to commonly cause invasive infections, including pyogenic liver abscess, bacteremia, pneumonia and endophthalmitis [17,19].…”

“…Despite the use of potent antibiotics with excellent in vitro activity, such as third-generation cephalosporins, the case fatality rate remains high [1][2][3].…”

“…In BM, acute breakdown of the bloodbrain barrier (BBB), and accumulation of blood-derived leukocytes in the cerebrospinal fluid(CSF) lead to brain edema, cerebral vasculitis, and ultimately neuronal injury [6,7]. In Taiwan, Klebsiellae pneumoniae is one of the most common causative pathogens of communityacquired bacterial meningitis, which is different from other parts of the world [3,8]. One of the prototypical destructive events in the human brain, initiated by the release of inflammatory cytokines and ending with tissue destruction, is production of matrix metalloproteinases (MMPs) [9].…”