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Acinetobacter meningitis: four nosocomial cases
W N Chang1, Y C Chuang, C H Lu
1Department of Neurology, Chang Gung Memorial Hospital-Kaohsiung, Taiwan.
Abstract:
We report the clinical features and therapeutic outcomes of four patients with multiantibiotic-resistant Acinetobacter meningitis. There were three males and one female, aged from 17 to 49 years. Three of them had suffered from head injuries with skull fractures, and the other suffered from an intracerebral hemorrhage and underwent a craniotomy. All four patients acquired nosocomial Acinetobacter meningitis, and multiantibiotic resistance developed. After treatment with imipenem/cilastatin, three of the four patients survived; one died of multiorgan failure. Because the clinical manifestations of Acinetobacter meningitis are similar to those of other gram-negative bacillary meningitis, the diagnosis can only be confirmed by bacterial culture. Resistance to multiple antibiotics, including third-generation cephalosporins, is frequently seen in patients with nosocomial Acinetobacter meningitis, and imipenem/cilastatin seems to be the antibiotic of choice for this potentially fatal central nervous system infection.
Insights
This study highlights multiantibiotic-resistant Acinetobacter meningitis, a serious nosocomial infection. Imipenem/cilastatin showed promise in treating these challenging central nervous system infections.
Area of Science:
- Infectious Diseases
- Neuroscience
- Clinical Microbiology
Background:
- Nosocomial meningitis poses a significant threat, particularly cases involving multiantibiotic-resistant bacteria.
- Acinetobacter species are increasingly recognized as challenging pathogens in healthcare settings.
Observation:
- Four patients presented with multiantibiotic-resistant Acinetobacter meningitis, often following head trauma or neurosurgery.
- Clinical presentation mimicked other gram-negative bacillary meningitis, necessitating bacterial culture for definitive diagnosis.
Findings:
- All four patients developed nosocomial Acinetobacter meningitis with resistance to multiple antibiotics, including third-generation cephalosporins.
- Treatment with imipenem/cilastatin resulted in survival for three of the four patients; one succumbed to multiorgan failure.
Implications:
- Early diagnosis through bacterial culture is crucial for Acinetobacter meningitis.
- Imipenem/cilastatin emerges as a potential treatment of choice for this severe central nervous system infection.
- Understanding resistance patterns is vital for managing Acinetobacter infections.