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Table 1 Clinical data and implicated pathogens in the super-infections of the study patients with adult bacterial meningitis

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

Case Gender Age (years) Underlying condition Initial pathogen(s) Antibiotics Management Interval* (days) New presentation New pathogen(s) Antibiotics Management Survived
More than 7 days interval*         
  Gram (+) → G (-) or G (-) → G (+)         
1 M 55 Infarct, craniectomy, EVD Staphylococcus aureus § LZD+EPM Removed EVD → new EVDs 61 Fever, leukocytosis, CSF pleocytosis ESBL-Escherichia coli MEP Removed EVD No
2 F 48 SICH, craniectomy, EVD Staphylococcus aureus § VA+CAZ Removed EVD → craniotomy, new EVDs 34 Fever, hydrocephalus Stenotrophomonas maltophilia # MOX+TMP+ TIG+ ATM Removed EVD → New EVD → removed EVD → VP shunt Yes
3 F 55 DM, SICH, craniotomy, VPS Staphylococcus aureus § VA Removed VPS, debridement → new EVD 11 Fever, CSF pleocytosis Acinetobacter baumannii LZD+MEP New EVD → ventriculo-pleural shunt Yes
4 F 41 SICH, craniectomy, EVD Staphylococcus epidermidis § VA Craniotomy, EVD → VPS 47 No Enterobacter cloacae + Pseudomonas aeruginosa CAZ Removed VPS No
5 M 73 TICH, craniectomy, EVD (removed) Coagulase-negative staphylococci§ VA New EVD 9 Fever, seizure, altered consciousness Enterobacter cloacae ROC Removed EVD → VP shunt Yes
6 M 46 TICH, craniectomy, VPS Coagulase-negative staphylococci§ VA Externalisation VPS → removed VPS → new EVDs 46 Fever Coagulase-negative staphylococci§ + Acinetobacter baumannii MEP Removed EVD → new EVDs → VP shunt Yes
7 M 34 Hydrocephalus, VPS Staphylococcus epidermidis § VA Removed VPS, New EVDs 28 Fever, CSF pleocytosis Acinetobacter spp CEF Removed EVD → New EVD → removed → VPS Yes
8 F 45 Lung cancer, meningeal metastasis, Omaya implant, infection Coagulase-negative staphylococci§ VA Debridement, removed Omaya implant 42 Fever Acinetobacter spp CAZ   Yes
9 F 48 Brain tumor, SICH, craniectomy Pseudomonas aeruginosa CEF New EVD 14 No Enterococcus spp AMP+CEF New EVD → Removed EVD Yes
10 M 67 DM, SICH, VPS, craniotomy, EVD Acinetobacter baumannii MEP Removed VPS, new EVDs 41 Fever Staphylococcus aureus § VA Removed EVD No
  Gram (-) → G (-)       
11A M 45 Brain tumor, SICH, craniectomy, VPS Serratia marcescens @ MEP Removed VPS, new EVD 29 Fever, reduced CSF glucose Stenotrophomonas maltophilia MOX+TMP Removed EVD → new EVD Treated
11B        90 No Candida glabrata FLU+AMB   Treated
11C        48 Fever Stenotrophomonas maltophilia # TMP+TIG   No
12 M 25 TICH, craniectomy, EVD Pseudomonas aeruginosa CAZ New EVDs 37 No Pseudomonas aeruginosa + ESBL-Proteus mirabilis MEP Removed EVD Yes
13 M 25 TICH, craniotomy, VPS Pseudomonas putida CAZ Removed VPS, new EVD 23 Leukocytosis Acinetobacter spp @ MEP+SBM Removed EVD → New EVDs → VPS Yes
14 M 64 SICH, VPS Serratia marcescens VA + MEP Removed VPS → new EVD 8 Fever, altered consciousness, hydrocephalus Acinetobacter baumannii @ MEP+SBM+ TIG+CST Removed EVD → new EVDs → VP shunt Yes
15A F 71 Old meningitis, hydrocephalus, VPS Morganella morganii CAZ Externalization VPS→ removed → new VPS 47 Fever Proteus mirabilis @ MEP Removed VPS Treated
15B        40 Fever Glucose non-fermenting bacilli@ MEP+SBM Scalp debridement → VPS Yes
16 M 31 TICH, craniotomy, EVD (removed) Stenotrophomonas maltophilia CAZ New EVDs 60 Fever Stenotrophomonas maltophilia + Pseudomonas aeruginosa MEP+CIP New EVDs → VPS → removed VPS → Omaya implant Yes
  Others       
17 F 58 SICH, EVD Staphylococcus epidermidis §+ Acinetobacter lwoffii VA+ROC+ CM Removed EVD, new EVD 28 No Staphylococcus epidermidis §+ Pseudomonas aeruginosa CAZ Removed EVD → New EVD → VPS Yes
18A M 48 TICH, craniectomy, EVD (removed) Escherichia coli MEP New EVDs → craniotomy 36 Scalp wound infection Candida tropicalis FLU removed EVD, debridement Treated
18B        9 No Escherichia coli+ Acinetobacter bauamnnii+ Enterococcus faecalis AMP Debridement → new EVD Treated
18C        11 Fever Staphylococcus aureus §+ Acinetobacter baumannii VA+IPM Removed EVD, new EVD Treated
18D        14 Fever Stenotrophomonas maltophilia CIP Removed EVD, new EVD → removed Yes
19 M 58 Head injury Viridan streptococci VA+ROC   8 Hydrocephalus, ventriculitis, CSF pleocytosis Prevotella+ Veilonella+ Fusobacterium VA+ROC+ MET New EVD No
Less than 7 days interval       
20 F 64 DM, VHD, SICH, craniectomy, EVD Escherichia coli+ Enterococcus faecalis VA+CAZ Removed EVD, New EVD 3 Fever, leukocytosis, CSF pleocytosis Enterobacter cloacae # @ VA+CAZ Removed EVD → VPS No
21 M 49 Liver cirrhosis, SICH, craniectomy, EVD (removed) Coagulase-negative staphylococci§ VA New EVD 5 No Enterobacter aerogenes CEF New EVDs No
  1. §Oxacillin-resistant; #change antibiogram during treatment; @ cephalosporin-resistant; *the time interval from the finding of previous pathogen(s) to the detection of the following new pathogen(s).
  2. Abbreviations: M, male; F, female; EVD, external ventricular drainage; SICH, spontaneous intra-cranial hemorrhage; DM, diabetes mellitus; VPS, ventriculo-peritoneal shunt; TICH, traumatic intra-cranial hemorrhage; ESBL, extended spectrum β-lactamase; LZD, linezolid; EPM, entrapenem; VA, vancomycin; CAZ, ceftazidime; CEF, cefepime; MEP, meropenem; ROC, ceftraixone; CM, chloroamphenicol; CSF, cerebrospinal fluid; MOX, moxifloxacin; TMP, trimethoprim-sulfamethoxazole; FLU, fluconazole; AMB, amphotericin B; TIG, tigecycline; SBM, sulbactam; ATM, aztreonam; CST, colistin; AMP, ampicillin; MET, metronidazole
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