Nosocomial meningitis with dual agents and treatment with intraventricular gentamicin

Nosocomial central nervous system infections constitute 0.4% of all nosocomial infections. The responsible pathogens of nosocomial meningitis are quite different from community-acquired meningitis with high rates of morbidity and mortality. The most important prognostic factor is the appropriate choice of pathogen-specific antibacterial therapy. In this report, a 64 years old woman with nosocomial meningitis caused by Klebsiella pneumonioe and Acinetobacter spp. after lumbar disc hernia operation, has been presented. The risk factors were detected as recent history of neurosurgical operation for three times and long term (29 days) use of external ventricular drainaige (EVD) catheter. Empirical meropenem (3 x 2 g, IV) and vancomycin (2 x 1 g, IV) therapy was initiated upon the diagnosis of nosocomial meningitis based on the clinical and laboratory findings on the postoperative fifth day. Extended-spectrum beta-lactamase (ESBL) producing K. pneumonice (susceptible to amikacin, imipenem, meropenem, cefoxitine, ciprofloxacin, piperasillin-tazobactam and trimethoprim/sulfamethoxazole) was recovered from cerebrospinal fluid (CSF) and blood samples obtained on the same day. There was no change in the status of the patient on the eighth day of meropenem therapy, with high leukocyte number (1300/mm(3)) and presence of gram-negative bacilli in CSF, and ESBL positive K. pneumonioe (antibiotic susceptibility pattern same with the previous isolate) growth in CSF culture. Thereupon intravenous ciprofloxacin (3 x 400 mg) was added to the therapy and her EVD has been changed. However, ESBL positive K. pneumonioe (antibiotic susceptibility pattern same with the previous isolate) together with Acinetobacter spp. (susceptible to gentamycin, tobramycin, netilmicin, ciprofloxacin, levofloxacin and cefepime) were isolated from CSF and blood cultures obtained on the 13(th) day of meropenem and fifth day of ciprofloxacin therapy. Therefore intraventricular and intravenous gentamicin (15 mg/days and 3 x 120 mg, respectively) were added to the therapy. The patient recovered at the end of three weeks treatment without any additional sequela other than her primary illness. This case was the first case of nosocomial meningitis due to ESBL positive K. pneumonioe together with Acinetobacter spp. in the available literature.

Dergi Adı MIKROBIYOLOJI BULTENI
Dergi Cilt Bilgisi 42
Dergi Sayısı 3
Sayfalar 497 - 501
Yayın Yılı 2008
Eser Adı
[dc.title]
Nosocomial meningitis with dual agents and treatment with intraventricular gentamicin
Yazar
[dc.contributor.author]
Oeztoprak, Nefise
Yazar
[dc.contributor.author]
Celebi, Gueven
Yazar
[dc.contributor.author]
Baruoenue, Fatma
Yazar
[dc.contributor.author]
Kalayci, Murat
Yayın Yılı
[dc.date.issued]
2008
Yayıncı
[dc.publisher]
ANKARA MICROBIOLOGY SOC
Yayın Türü
[dc.type]
article
Özet
[dc.description.abstract]
Nosocomial central nervous system infections constitute 0.4% of all nosocomial infections. The responsible pathogens of nosocomial meningitis are quite different from community-acquired meningitis with high rates of morbidity and mortality. The most important prognostic factor is the appropriate choice of pathogen-specific antibacterial therapy. In this report, a 64 years old woman with nosocomial meningitis caused by Klebsiella pneumonioe and Acinetobacter spp. after lumbar disc hernia operation, has been presented. The risk factors were detected as recent history of neurosurgical operation for three times and long term (29 days) use of external ventricular drainaige (EVD) catheter. Empirical meropenem (3 x 2 g, IV) and vancomycin (2 x 1 g, IV) therapy was initiated upon the diagnosis of nosocomial meningitis based on the clinical and laboratory findings on the postoperative fifth day. Extended-spectrum beta-lactamase (ESBL) producing K. pneumonice (susceptible to amikacin, imipenem, meropenem, cefoxitine, ciprofloxacin, piperasillin-tazobactam and trimethoprim/sulfamethoxazole) was recovered from cerebrospinal fluid (CSF) and blood samples obtained on the same day. There was no change in the status of the patient on the eighth day of meropenem therapy, with high leukocyte number (1300/mm(3)) and presence of gram-negative bacilli in CSF, and ESBL positive K. pneumonioe (antibiotic susceptibility pattern same with the previous isolate) growth in CSF culture. Thereupon intravenous ciprofloxacin (3 x 400 mg) was added to the therapy and her EVD has been changed. However, ESBL positive K. pneumonioe (antibiotic susceptibility pattern same with the previous isolate) together with Acinetobacter spp. (susceptible to gentamycin, tobramycin, netilmicin, ciprofloxacin, levofloxacin and cefepime) were isolated from CSF and blood cultures obtained on the 13(th) day of meropenem and fifth day of ciprofloxacin therapy. Therefore intraventricular and intravenous gentamicin (15 mg/days and 3 x 120 mg, respectively) were added to the therapy. The patient recovered at the end of three weeks treatment without any additional sequela other than her primary illness. This case was the first case of nosocomial meningitis due to ESBL positive K. pneumonioe together with Acinetobacter spp. in the available literature.
Açıklama
[dc.description]
WOS: 000258416900016
Açıklama
[dc.description]
PubMed: 18822895
Kayıt Giriş Tarihi
[dc.date.accessioned]
2019-12-23
Açık Erişim Tarihi
[dc.date.available]
2019-12-23
Yayın Dili
[dc.language.iso]
tur
Konu Başlıkları
[dc.subject]
nosocomial meningitis
Konu Başlıkları
[dc.subject]
extended-spectrum beta-lactamase
Konu Başlıkları
[dc.subject]
Klebsiella pneumoniae
Konu Başlıkları
[dc.subject]
Acinetobacter spp.
Konu Başlıkları
[dc.subject]
intraventricular antibiotic treatment
Haklar
[dc.rights]
info:eu-repo/semantics/closedAccess
ISSN
[dc.identifier.issn]
0374-9096
İlk Sayfa Sayısı
[dc.identifier.startpage]
497
Son Sayfa Sayısı
[dc.identifier.endpage]
501
Dergi Adı
[dc.relation.journal]
MIKROBIYOLOJI BULTENI
Dergi Sayısı
[dc.identifier.issue]
3
Dergi Cilt Bilgisi
[dc.identifier.volume]
42
Tek Biçim Adres
[dc.identifier.uri]
https://hdl.handle.net/20.500.12628/3014
Görüntülenme Sayısı ( Şehir )
Görüntülenme Sayısı ( Ülke )
Görüntülenme Sayısı ( Zaman Dağılımı )
Görüntülenme
17
09.12.2022 tarihinden bu yana
İndirme
1
09.12.2022 tarihinden bu yana
Son Erişim Tarihi
06 Şubat 2024 23:52
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Tıklayınız
therapy meningitis nosocomial pneumonioe ciprofloxacin meropenem Acinetobacter positive together operation (antibiotic susceptibility intravenous pattern previous obtained (susceptible infections recovered patient isolate) trimethoprim/sulfamethoxazole) cerebrospinal leukocyte samples change bacilli gram-negative presence (1300/mm(3)) number eighth status Nosocomial growth
6698 sayılı Kişisel Verilerin Korunması Kanunu kapsamında yükümlülüklerimiz ve çerez politikamız hakkında bilgi sahibi olmak için alttaki bağlantıyı kullanabilirsiniz.

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