Iatrogenic bacterial meningitis: an unmasked threat

Abstract

Iatrogenic bacterial meningitis (IBM) is a rare but serious complication of neuraxial procedures, such as spinal and epidural anesthesia or lumbar puncture. We report a case of a 46-year-old female who presented to the emergency department with bacterial meningitis after spinal anesthesia. We review the existing literature outlining the pathogenesis, vector hypothesis, diagnosis, treatment, and prevention as they relate to IBM. We highlight the role of the emergency physician in the rapid diagnosis of this disease, and underscore the need for sterile technique when performing lumbar punctures. RÉ SUMÉLa mé ningite bacté rienne iatrogé nique (MBI) est une complication rare mais grave d'interventions centrales comme la rachianesthé sie, l'anesthé sie pé ridurale, et la ponction lombaire. Il sera ici question du cas d'une femme de 46 ans, qui s'est pré senté e au service d'urgence pour une mé ningite bacté rienne aprè s une rachianesthé sie. Nous passerons en revue la documentation actuelle et exposerons briè vement la pathogenè se de la MBI, les vecteurs possibles, le diagnostic, le traitement, et la pré vention de la maladie. Nous ferons ensuite ressortir le rô le de l'urgentologue dans la pose rapide du diagnostic et insisterons sur la né cessité de la sté rilité des techniques dans les ponctions lombaires.

Neuraxial Anesthesia and the Use of Sterile Gowning

“…Patients undergoing neuraxial anesthesia are at risk for infections that can lead to complications such as arachnoiditis, epidural abscess, meningitis, sepsis, cardiac arrest, or death 1‐7 . Infectious complications are known to cause serious and devastating morbidity and mortality; however, until recently, anesthesia professionals believed these complications to be rare in patients receiving neuraxial anesthesia 1‐7 . In the past 10 years, new studies have shown a higher incidence of infectious complications associated with neuraxial anesthesia than were previously reported 8,9 …”

Streptococcus salivarius kot povzročitelj iatrogenega meningitisa – predstavitev primera

“…in Pseudomonas spp. ; med njimi so najpogosteje dokazani zeleneči streptokoki (1,3). Streptococcus salivarius je pomemben povzročitelj iatrogenega meningitisa (4).…”

“…Meningitis je redek zaplet in je mikrobiološko potrjen le v 0,3-5 % primerov (6). Med zelenečimi streptokoki je najpogostejši povzročitelj iatrogenega meningitisa S. salivarius (3). Lahko povzroča še infekcijski endokarditis, sepso in bakteriemijo pri imunsko oslabelih bolnikih (8).…”