Klebsiella oxytoca meningitis: Frequent association with neurosurgical procedures

Abstract

Klebsiella oxytoca meningitis is a rare condition. Nine patients were diagnosed between 1981 and 1993 at our institution. These accounted for 2.3% of 393 patients with blood and/or cerebrospinal fluid culture-proven bacterial meningitis. K. oxytoca was noted in both community-acquired meningitis and nosocomial meningitis. Eight of the nine cases were patients who had undergone neurosurgical procedures. Four were mixed bacterial meningitis. All K. oxytoca isolates were susceptible to third-generation cephalosporins and all but one to chloramphenicol. Antibiotic therapy was successful in eight patients but failed in one.

Epidemiology, Diagnosis, and Antimicrobial Treatment of Acute Bacterial Meningitis

“…Klebsiella species, Acinetobacter baumannii, Escherichia coli, Pseudomonas aeruginosa, and other aerobic Gram-negative bacteria can cause bacterial meningitis after head trauma or neurosurgical procedures (172,262,299,300). Postneurosurgical meningitis caused by aerobic Gram-negative bacteria can occur late after surgery; the median time to the development of Acinetobacter meningitis after a neurosurgical procedure was found to be 12 days (range, 1 to 40 days) (285).…”

Klebsiella Brain Abscess in Adults

“…account for a significant proportion of urinary tract, bloodstream, hepatobiliary tract and lung infections. In Taiwan, Klebsiella infection has been known to commonly cause invasive infection, including pyogenic liver abscess, bacteremia, pneumonia, endophthalmitis and meningitis [5][6][7][8][9][10]. They have been recognized as uncommon brain abscess-causing pathogens in adults [3,4,16], but the incidence seems to be increasing [5,6].…”

“…Metastatic septic abscesses such as pyo- genic liver abscess, arthritis, pericarditis, pyomyositis, brain abscesses and endophthalmitis were devastating complications found with K. pneumoniae septicemia, but only otogenic infection was found in K. oxytoca patients. In fact, K. oxytoca has seldom been described in cases of infection of the CNS [9], and is also rare as a cause of otogenic brain abscess [17][18].…”

“…Klebsiella species, once thought to be a less common cause of brain abscess in adults [3,4], have become an increasingly important cause of brain abscess particularly in patients with impaired host defenses, head trauma, or neurosurgical operations [5,6]. In Taiwan, Klebsiella infection is known to cause pyogenic liver abscess, meningitis, septicemia, pneumonia and endophthalmitis [5][6][7][8][9][10]. However, there have been few studies conducted on Klebsiella brain abscesses.…”

Adrenal Hemorrhage Associated with Klebsiella Oxytoca Bacteremia.

“…It maycause infection, such as pneumonia (6), meningitis (7), or endocarditis (8), but this is rare. Infections are found in patients who have undergone surgical or invasive procedures (7)(8)(9). Klebsiella oxytoca is recognized as an important nosocomial pathogen (6,7).…”