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

Huang, Chi-Ren; Chen, Shu-Fang; Lu, Cheng-Hsien; Chuang, Yao-Chung; Tsai, Nai-Wen; Chang, Chiung-Chih; Wang, Hung-Chen; Chien, Chun-Chih; Chang, Wen-Neng

doi:10.1186/1471-2334-11-133

BMC Infectious Diseases

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

^§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).
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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ISSN: 1471-2334

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