Management of meningitis due to antibiotic-resistant Acinetobacter species

Kim, Baek-Nam; Peleg, Anton Y.; Lodise, Thomas P.; Lipman, Jeffrey; Li, Jian; Nation, Roger L.; Paterson, David L.

doi:10.1016/s1473-3099(09)70055-6

Cited by 200 publications

(161 citation statements)

References 143 publications

Supporting

Mentioning

149

Contrasting

Unclassified

Order By: Relevance

“…In a recent review, intrathecal plus systemic therapy was recommended for treatment of ANM patients. 17 Risk factors are important in predicting the outcomes of ANM patients. A case-control study showed a higher incidence of hydrocephaly in patients with Acinetobacter.…”

Section: Discussionmentioning

confidence: 99%

Mortality rate in patients with nosocomial Acinetobacter meningitis from a Brazilian hospital

Tuon¹,

Penteado-Filho²,

Amarante³

et al. 2010

Braz J Infect Dis

View full text Add to dashboard Cite

Background:The mortality rate due to Acinetobacter baumannii nosocomial meningitis (ANM) is high. Objective: The aim of this study was to evaluate the factors that have infl uence over the outcomes in ANM patients. Methods: A retrospective analysis of 22 cases of ANM was conducted in a hospital with high incidence of multidrug resistance. Results: The mean age of patients was 43 years (21 to 91) and 54.5% were male. All ANM cases occurred within 60 days of admission and the mean duration of illness was of 18.2 days. All cases were associated with previous neurosurgical procedures: elective surgery (27.2%), external shunt (54.4%) and emergency surgery due to trauma (18.1%). Imipenem resistance was observed in 40.9% of cases, but ampicillin/sulbactam resistance was lower (27.2%). The mortality rate of ANM patients was of 72.7%. The only risk factor associated with mortality was inappropriate therapy within fi ve days after CSF collection. All patients who survived the meningitis episode had received appropriate therapy, in contrast to only 69.2% of those who did not survive (OR = 5.15; IC = 0.45-54.01). Conclusions: The high mortality rate observed in our study suggests the need for aggressive empirical treatment with addition of drugs, including intrathecal therapy, where multi-resistant A. baumannii is endemic.

show abstract

Section: Discussionmentioning

confidence: 99%

Mortality rate in patients with nosocomial Acinetobacter meningitis from a Brazilian hospital

Tuon¹,

Penteado-Filho²,

Amarante³

et al. 2010

Braz J Infect Dis

View full text Add to dashboard Cite

show abstract

“…remain very important pathogens with an increasing resistance to several antibiotic classes, a disturbing occurrence that affects patients' care all over the world. 10 The finding that almost 40% of patients who underwent craniotomy in our prospective study developed at least one infection is disturbing, and it should alert physicians and investigators to search for the factors that will help in the mitigation of such complications in neurosurgical patients.…”

Section: Microbiology Of Other Infectionsmentioning

confidence: 92%

“…is their increasing resistance to almost all antibiotic classes (including carbapenems), which has been a significant problem in the recent years. 1,4,10,16,22,25,30,36 Klebsiella spp. were the second most commonly isolated pathogens in this cohort, with the isolates carrying a high degree of resistance to third-generation cephalosporins and carbapenems (Table 4).…”

Section: Meningitismentioning

confidence: 99%

Infections in patients undergoing craniotomy: risk factors associated with post-craniotomy meningitis

Kourbeti¹,

Vakis²,

Ziakas

et al. 2015

JNS

141

View full text Add to dashboard Cite

OBJECT The authors performed a prospective study to define the prevalence and microbiological characteristics of infections in patients undergoing craniotomy and to clarify the risk factors for post-craniotomy meningitis. METHODS Patients older than 18 years who underwent nonstereotactic craniotomies between January 2006 and December 2008 were included. Demographic, clinical, laboratory, and microbiological data were systemically recorded. Patient characteristics, craniotomy type, and pre- and postoperative variables were evaluated as risk factors for meningitis RESULTS Three hundred thirty-four procedures were analyzed (65.6% involving male patients). Traumatic brain injury was the most common reason for craniotomy. Almost 40% of the patients developed at least 1 infection. Ventilatorassociated pneumonia (VAP) was the most common infection recorded (22.5%) and Acinetobacter spp. were isolated in 44% of the cases. Meningitis was encountered in 16 procedures (4.8%), and CSF cultures were positive for microbial growth in 100% of these cases. Gram-negative pathogens (Acinetobacter spp., Klebsiella spp., Pseudomonas aeruginosa, Enterobacter cloaceae, Proteus mirabilis) represented 88% of the pathogens. Acinetobacter and Klebsiella spp. demonstrated a high percentage of resistance in several antibiotic classes. In multivariate analysis, the risk for meningitis was independently associated with perioperative steroid use (OR 11.55, p = 0.005), CSF leak (OR 48.03, p < 0.001), and ventricular drainage (OR 70.52, p < 0.001). CONCLUSIONS Device-related postoperative communication between the CSF and the environment, CSF leak, and perioperative steroid use were defined as risk factors for meningitis in this study. Ventilator-associated pneumonia was the most common infection overall. The offending pathogens presented a high level of resistance to several antibiotics.

show abstract

“…Although nosocomial pneumonia is the most common clinical manifestation, Acinetobacter meningitis has been increasing in frequency [3]. Acinetobacter meningitis may occur following neurosurgery, traumatic head injury or/and metastatic infection in bacteremic patients.…”

Section: Introductionmentioning

confidence: 99%

“…The mortality rate of central nervous system infection due to MDRA has been reported to range from 15-71% [3]. There are very few published studies of neurological outcomes in pediatric MDRA meningitis cases [8,9].…”

Section: Introductionmentioning

confidence: 99%

Acinetobacter species meningitis in children: a case series from Karachi, Pakistan

Saleem

Shah

Shaikh

et al. 2011

J Infect Dev Ctries

View full text Add to dashboard Cite

Introduction: Multidrug-resistant strains of Acinetobacter pose a serious therapeutic dilemma in hospital practice, particularly when they cause meningitis, as the few antimicrobial agents to which these isolates are susceptible have poor central nervous system (CNS) penetration. Methodology: We retrospectively reviewed the clinical course and outcome of eight consecutive cases of meningitis due to Acinetobacter spp. in children ages 15 years or less, seen in a tertiary care medical center in Karachi, Pakistan. Results: Of the eight cases of Acinetobacter meningitis, isolates from five patients were pan-resistant, and two were multidrug-resistant. A neurosurgical procedure was performed in five of eight patients followed by external ventricular drain insertion prior to the development of infection. Seven received intravenous (IV) polymyxin (mean; 12.8 days), while 5/8 also received intrathecal (IT) polymyxin (mean; 12.0 days). The mean length of hospitalization was 38.7 ± 19 days. All patients achieved cerebrospinal fluid (CSF) culture negativity by the end of treatment (mean; 5.4 days). Two patients died: one with pan-resistant Acinetobacter, and the second with a multi-drug resistant isolate. Conclusion: Post-neurosurgical multidrug-resistant and pan-resistant Acinetobacter meningitis can be successfully treated if appropriate antimicrobial therapy is instituted early. The role of IT polymyxin B administration alone versus combination therapy (IV and IT) needs further study.

show abstract

Management of meningitis due to antibiotic-resistant Acinetobacter species

Cited by 200 publications

References 143 publications

Mortality rate in patients with nosocomial Acinetobacter meningitis from a Brazilian hospital

Mortality rate in patients with nosocomial Acinetobacter meningitis from a Brazilian hospital

Infections in patients undergoing craniotomy: risk factors associated with post-craniotomy meningitis

Acinetobacter species meningitis in children: a case series from Karachi, Pakistan

Contact Info

Product

Resources

About