Influence of Third-generation Cephalosporin Resistance on Adult In-hospital Mortality From Post-neurosurgical Bacterial Meningitis

Chang, Chia-Jung; Ye, Jung-Jr; Yang, Chien-Chang; Huang, Po-Yen; Chiang, Ping-Cherng; Lee, Ming-Hsun

doi:10.1016/s1684-1182(10)60047-3

Cited by 24 publications

(24 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Third-generation cephalosporin-resistant strains have become increasingly common in our study, which was also found in recent studies [43][44][45]. The resistance of Ab and KP to ceftriaxone/ceftazidime was 90.0%/87.1% and 75.7%/61.8%, which is in accordance with the other studies [35,46].…”

Section: Discussionsupporting

confidence: 92%

The microbiology and clinical characteristics of bacterial and fungal meningitis in a Chinese hospital

Chen¹,

Hu²,

Liu³

2017

Arch Med Sci Civil Dis

View full text Add to dashboard Cite

A b s t r a c t Introduction:The aim was to investigate the distribution, antibiotic resistance, initial clinical and laboratory characteristics of pathogens isolated from the cerebrospinal fluid samples (CSF). Material and methods: The CSF were subjected for identification. The minimum inhibitory concentrations (MICs) of antimicrobial agents were tested. The initial clinical and laboratory characteristics were collected. Results: The rate of positive yield of pathogen meningitis in our study was 8.16% . Among the 1994 non-repetitive pathogens, Gram-positive pathogen was the most common (71.71%), followed by Gram-negative pathogen (20.36%), fungal (6.62%) and Mycobacterium tuberculosis (1.30%). Coagulase-negative staphylococci (CNS) was the most common Gram-positive pathogen and Acinetobacter baumannii (Ab) was the most common Gram-negative pathogen. As to fungal pathogen, Cryptococcus neoformans (CN) was the most common. The main CNS showed higher antimicrobial resistant rate for Penicillin G, oxacillin, clindamycin and erythromycin. Acinetobacter baumannii resistant to the most tested antibiotics and only showed considerable rate of resistance to cefoperazone/sulbactam, tigecycline and amikacin. All CN were susceptible to 5-fluorocytosine and only 3.6% CN were resistance to fluconazole. Long days of hospital stay, fever and meningeal irritation signs were common symptoms in the bacterial and fungal meningitis. Head injury, disturbance of consciousness, the pupil size of both eyes was not equal, pupillary reaction to light was slow or absent were more common in the Ab meningitis. The CSF protein concentration and white blood cells count as well as glucose concentration can be used in guiding initial treatment and further microbiological investigation. Conclusions: The main pathogens showed higher antimicrobial resistant rate and the selection of empiric antibiotics should take into consideration local epidemiology, antibiotic resistance patterns and the suspected causative microorganism.

show abstract

Section: Discussionsupporting

confidence: 92%

The microbiology and clinical characteristics of bacterial and fungal meningitis in a Chinese hospital

Chen¹,

Hu²,

Liu³

2017

Arch Med Sci Civil Dis

View full text Add to dashboard Cite

show abstract

“…Intermediate and resistant isolates were considered non-susceptible [11]. Multi-drugs resistant (MDR) GNB was used to describe isolates that were non-susceptible to all antibiotics routinely tested including amikacin, (ampicillin-sulbactam in A. baumannii ), ceftriaxone, ceftazidime, cefepime, ciprofloxacin, imepenem, and meropenem [12,13].…”

Section: Resultsmentioning

confidence: 99%

“…Another important therapeutic consideration in antibiotic use is the emergence of multi-drug resistant bacterial strains in G(-) ABM [11-13,20-25]. This problem is notable especially in patients with underlying G(-) ABM and a super-infection caused by another G(-) pathogen.…”

Section: Discussionmentioning

confidence: 99%

Clinical characteristics and therapeutic outcomes of nosocomial super-infection in adult bacterial meningitis

Huang

Chen

et al. 2011

BMC Infect Dis

View full text Add to dashboard Cite

BackgroundSuper-infection in adult bacterial meningitis (ABM) is a condition wherein the cerebrospinal fluid (CSF) grows new pathogen(s) during the therapeutic course of meningitis. It is an uncommon but clinically important condition rarely examined in literature.MethodsTwenty-seven episodes of super-infection states in 21 ABM patients collected in a 9.5-year study period (January 2001 to June 2010) were evaluated. The clinical characteristics, implicated pathogens, results of antimicrobial susceptibility tests, and therapeutic outcomes were analyzed.ResultsTwenty-one patients (13 men, 8 women) aged 25-73 years (median, 45 years) had post-neurosurgical state as the preceding event and nosocomial infection. The post-neurosurgical states included spontaneous intracranial hemorrhage (ICH) with craniectomy or craniotomy with extra-ventricular drainage (EVD) or ventriculo-peritoneal shunt (VPS) in 10 patients, traumatic ICH with craniectomy or craniotomy with EVD or VPS in 6 patients, hydrocephalus s/p VPS in 2 patients, and one patient each with cerebral infarct s/p craniectomy with EVD, meningeal metastasis s/p Omaya implant, and head injury. All 21 patients had EVD and/or VP shunt and/or Omaya implant during the whole course of ABM. Recurrent fever was the most common presentation and the implicated bacterial pathogens were protean, many of which were antibiotic resistant. Most patients required adjustment of antibiotics after the pathogens were identified but even with antimicrobial therapy, 33.3% (7/21) died. Morbidity was also high among survivors.ConclusionsSuper-infection in ABM is usually seen in patients with preceding neurosurgical event, especially insertion of an external drainage device. Repeat CSF culture is mandatory for diagnostic confirmation because most of the implicated bacterial strains are non-susceptible to common antibiotics used. Unusual pathogens like anaerobic bacteria and fungi may also appear. Despite antimicrobial therapy, prognosis remains poor.

show abstract

“…"Relapse" of meningitis was considered if it was also caused by S. marcescens within 3 weeks of the completion of therapy for the initial episode. 16,20 Descriptive epidemiology Data collected from the enrolled patients included demographics, comorbid illnesses, clinical presentations and diagnoses, neurosurgeries in recent 3 months, laboratory data, severity of illness [Glasgow Coma Scale (GCS) score and Sequential Organ Failure Assessment (SOFA) score], 21 treatment courses and outcomes. Comorbid illnesses included diabetes mellitus, hepatic dysfunction (defined as the serum total bilirubin level !2.0 mg/dL or liver cirrhosis), renal insufficiency (defined as a serum creatinine level !2.0 mg/dL or a requirement of hemodialysis), chronic lung diseases, heart failure, and hematologic or solid organ malignancies.…”

Section: Study Design Patients and Case Definitionmentioning

confidence: 99%

“…16 However, the literature concerning the risk factors, impacts of antimicrobial therapy and clinical outcomes for S. marcescens meningitis were limited. Hence, we conducted this retrospective study to investigate the epidemiology, prognostic factors, and treatment outcomes of S. marcescens meningitis.…”

Section: Introductionmentioning

confidence: 99%

Serratia marcescens meningitis: Epidemiology, prognostic factors and treatment outcomes

Hsu

Yang

et al. 2013

Journal of Microbiology, Immunology and Infection

Self Cite

View full text Add to dashboard Cite

show abstract

Influence of Third-generation Cephalosporin Resistance on Adult In-hospital Mortality From Post-neurosurgical Bacterial Meningitis

Cited by 24 publications

References 25 publications

The microbiology and clinical characteristics of bacterial and fungal meningitis in a Chinese hospital

The microbiology and clinical characteristics of bacterial and fungal meningitis in a Chinese hospital

Clinical characteristics and therapeutic outcomes of nosocomial super-infection in adult bacterial meningitis

Serratia marcescens meningitis: Epidemiology, prognostic factors and treatment outcomes

Contact Info

Product

Resources

About