Gram-negative bacillary meningitis

Mangi, Richard J.; Quintiliani, Richard; Andriole, Vincent T.

doi:10.1016/0002-9343(75)90468-4

Cited by 104 publications

(34 citation statements)

References 45 publications

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“…1,2,15,18,19 GNR meningitis has been associated with GNR bacteremia, preterm birth, male sex, neural tube defects, and urinary tract anomalies. 14,15,20 Diagnosis by culture is often complicated by empirical use of antibiotics and delay in LP.…”

Section: Discussionmentioning

confidence: 99%

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A comparison of neonatal Gram-negative rod and Gram-positive cocci meningitis

et al. 2006

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Objective: Neonatal meningitis is an illness with potentially devastating consequences. Early identification of potential risk factors for Gram-negative rod (GNR) infections versus Gram-positive cocci (GPC) infection prior to obtaining final culture results is of value in order to appropriately guide expirical therapy. We sought to compare laboratory and clinical parameters of GNR and GPC meningitis in a cohort of term and premature infants.Study Design: We evaluated lumbar punctures from neonates cared for at 150 neonatal intensive care units managed by the Pediatrix Medical Group Inc. We compared cerebrospinal fluid (CSF) parameters (white blood cell count, red blood cell count, glucose, and protein), demographics, and outcomes between infants with GNR and GPC meningitis. CSF cultures positive with coagulase-negative staphylococci were excluded. Results:We identified 77 infants with GNR and 86 with GPC meningitis. There were no differences in gestational age, birth weight, infant sex, race, or rate of Caesarean section. GNR meningitis was more often diagnosed after the third postnatal day and was associated with higher white blood cell and red blood cell counts. GNR meningitis diagnosed in the first 3 days of life was associated with antepartum antibiotic exposure. No difference was noted in either CSF protein or glucose levels. After correcting for gestational age, there was no observed difference in mortality between infants infected with GNR or GPC.Conclusion: Compared to GPC meningitis, GNR meningitis was associated with several aspects of the clinical history and laboratory findings including older age of presentation, antepartum exposure to antibiotics, and elevated CSF white blood cell and red blood cell counts.

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Section: Discussionmentioning

confidence: 99%

“…25 Also, consistent with previous studies, E. coli was found to be the most commonly isolated GNR. 2,11,14,15 This study provides contemporary data evaluating Figure 2 Mortality by organism. mortality rates of meningitis caused by several types of bacteria, including GBS.…”

Section: Discussionmentioning

confidence: 99%

A comparison of neonatal Gram-negative rod and Gram-positive cocci meningitis

et al. 2006

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“…It is considered the drug of choice for meningitis due to ampicillin-resistant Haemophilus influenzae and for pneumococcal and meningococcal meningitis in patients allergic to penicillin. Recently, enteric gram-negative bacfilary meningitis has been noted more frequently among adults undergoing neurosurgical procedures and in those with debilitating disease (7). Antibiotic susceptibility of these pathogens is often limited to chloramphenicol and aminoglycosides.…”

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confidence: 99%

Bactericidal and Bacteriostatic Action of Chloramphenicol Against Meningeal Pathogens

Rahal

Simberkoff

1979

Antimicrob Agents Chemother

161

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The bacteriostatic and bactericidal effects of chloramphenicol, ampicillin, tetracycline, and sulfisoxazole were compared against several potential meningeal pathogens. Chloramphenicol is bactericidal at clinically achievable concentrations against Haemophilus influenzae, Streptococcuspneumoniae, and Neisseria meningitidis. It is bacteriostatic against gram-negative bacilli of the farnily Enterobacteriaceae and against Staphylococcus aureus. Chloramphenicol has proven highly efficacious in the treatment of bacterial meningitis caused by those organisms against which it is bactericidal at low concentrations. Because leukocytic phagocytosis in the subarachnoid space is inefficient, we propose that bactericidal activity in cerebrospinal fluid is important for optimal therapy of bacterial meningitis. Chloramphenicol does not provide such activity in meningitis caused by enteric gram-negative bacilli.Chloramphenicol has assumed an increasingly important role in the therapy of pyogenic meningitis. It is considered the drug of choice for meningitis due to ampicillin-resistant Haemophilus influenzae and for pneumococcal and meningococcal meningitis in patients allergic to penicillin. Recently, enteric gram-negative bacfilary meningitis has been noted more frequently among adults undergoing neurosurgical procedures and in those with debilitating disease (7). Antibiotic susceptibility of these pathogens is often limited to chloramphenicol and aminoglycosides. When chloramphenicol susceptibility is known, this drug has been favored as the treatment of choice because of its greater penetrability from serum to cerebrospinal fluid (11 and an inoculum of 105 organisms per ml. One-half milliliter of inoculum was added to 0.5 ml of each antibiotic dilution, and the suspensions were incubated for 18 h at 370C. The minimal inhibitory concentration (MIC) was defined as the lowest concentration of antibiotic preventing visible turbidity. All clear tubes were subcultured with a calibrated loop (0.01 ml) onto antibiotic-free agar for 18 h at 37°C. The minimal bactericidal concentration (MBC) was defined as that yielding growth of fewer than five colonies (>99% killing). Supplement C (2.5%, Difco) was added for determination of H. influenzae susceptibility. Quantitative studies of bacterial killing rates were performed with 2-mi suspensions containing 105 organisms per ml. Aliquots of 0.1 ml were removed at timed intervals, and colony-forming units were counted by the standard plate dilution technique. RESULTSEleven strains of H. influenzae, 10 strains of S. pneumoniae, and 10 strains ofN. meningitidis were tested for their bacteriostatic and bactericidal susceptibility to chloramphenicol, ampicillin, and tetracycline. Susceptibility of the N. meningitidis strains to sulfisoxazole was also tested.Against H. influenzae, the MIC of chloramphenicol was at least twofold lower than that of ampicillin for 10 of 11 strains. The MBC of chloramphenicol was at least twofold lower than that of ampicillin for six strains and equal to that of ampic...

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“…Most cases of neonatal or postneurosurgical meningitis are now caused by the Enterobacteriaceae or Pseudomonas (7,9,11). The mortality rate and frequency of neurological sequelae remain high (2,17).…”

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confidence: 99%

Mecillinam-Ampicillin Synergism in Experimental Enterobacteriaceae Meningitis

Scheld

Fink

Fletcher

et al. 1979

Antimicrob Agents Chemother

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The in vitro activities of mecillinam, a new f)-amidinopenicilhin, and ampicillin, alone and in combination, against an Escherichia coli strain and a Klebsiella pneumoniae strain were compared, and these results were correlated with their respective activities in vivo in experimental meningitis. The mecillinam-ampicillin combination was synergistic in vitro against both strains when tested by a modified checkerboard technique (bacteriostatic synergy). However when quantitative bactericidal synergy studies were made, the relative bactericidal rate of the combination was more rapid than that of either drug alone ("bactericidal synergy") against the Escherichia coli isolate only. In a rabbit model of Enterobacteriaceae meningitis, in vivo bactericidal activity correlated with results obtained in vitro. Both drugs were administered by continuous intravenous infusion for 8 h. Serum and cerebrospinal fluid antibiotic levels were similar to those achieved in humans. Cerebrospinal fluid bacterial concentrations (colonyforming units [CFU] per milliliter) were quantitatively titrated at 2-h intervals. Both drugs, alone or the combination, were ineffective against the K. pneumoniae strain in vivo (change in titer <1 log in 8 h). In contrast, the combination produced a markedly enhanced bactericidal effect against the E. coli strain (mean + standard deviation, decrease of log1o CFU per milliliter of 3.65 ± 1.02) compared with those of ampicillin alone (decrease of log1o CFU per milliter of 0.07 ± 0.8) and mecillinam alone (decrease of logio CFU per milliliter of 1.6 ± 0.05) (P < 0.001). When bactericidal synergism can be demonstrated for mecillinam-ampicillin in vitro in a case of gram-negative-bacillary meningitis this combination may be useful in the therapy of the illness.

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Gram-negative bacillary meningitis

Cited by 104 publications

References 45 publications

A comparison of neonatal Gram-negative rod and Gram-positive cocci meningitis

A comparison of neonatal Gram-negative rod and Gram-positive cocci meningitis

Bactericidal and Bacteriostatic Action of Chloramphenicol Against Meningeal Pathogens

Mecillinam-Ampicillin Synergism in Experimental Enterobacteriaceae Meningitis

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