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Cerebrospinal meningitis with the presence of Acinetobacter spp
E Gospodarek1, K Kraśnicki, G Ziółkowski
1Department of Microbiology, Medical University, ul. M. Curie-Sldodowskiej 9, 85-094 Bydgoszcz, Poland.
Abstract:
The study was conducted on 16 strains of Acinetobacter sp. which were isolated from cerebrospinal fluid. The diagnostic material was analysed with the use of automatic BacT/Alert system (Organon Teknika). The analysis was performed in the Department of Microbiology, Medical University in Bydgoszcz. API 20NE system (bioMérieux) enabled the identification of 14 strains (87.5%) as A. baumannii, 1 strain as A. haemolyticus and 1 strain as A. lwoffii. The micro-organisms were isolated from patients whose age ranged between 4 and 66 years. These patients were treated in the departments of Neurosurgery (75.0%), Neurology (18.8%) and Intensive Therapy (6.2%). The infection of cerebrospinal fluid was caused by injury and subsequent exposure to the bacteria present in external environment. Antibiotic-sensitivity of these micro-organisms was evaluated with the help of disc-diffusion method, observing standardisation conditions outlined by NCCLS. All the strains proved sensitive to carbapenems, 15 strains were sensitive to netilmicin, 7 strains--to tobramycin and 7 strains--to amikacin. All the strains displayed multiple resistance. The only exception was A. haemolyticus. The use of two-discs allowed for the detection of ESBLs in 7 A. baumannii strains. Positive results were most frequently obtained after the combination of sublactam and aztreonam. Due to microscopic resemblance between Acinetobacter spp., and bacteria of Neisseria, Moraxella and Haemophilus genus, microbiological diagnostics should not be restricted to microscopic assessment of cerebrospinal fluid and quick serological tests evaluating the antigens of the most frequent aetiological factors. Considering multiple resistance of Acinetobacter spp. to antibiotics, the treatment should be based on sensitivity tests and the ability of a given antibiotic to penetrate into cerebrospinal fluid. In our opinion, both reasonable antibiotic policy as well as observing the principles of hygiene and monitoring infections play equally important roles in the prevention of infections with Acinetobacter spp. Such combined measures may help to prevent the spreading of multiple resistant strains in hospital environment.
Insights
This study identified Acinetobacter baumannii in cerebrospinal fluid infections, finding all strains resistant to multiple antibiotics. Effective treatment requires sensitivity testing and good hygiene practices to prevent spread.
Area of Science:
- Medical Microbiology
- Infectious Diseases
Background:
- Acinetobacter species are significant opportunistic pathogens, particularly in hospital-acquired infections.
- Cerebrospinal fluid (CSF) infections caused by Acinetobacter pose diagnostic and therapeutic challenges.
Purpose of the Study:
- To characterize Acinetobacter strains isolated from CSF, including species identification and antibiotic susceptibility.
- To evaluate the prevalence of extended-spectrum beta-lactamases (ESBLs) in these strains.
- To provide recommendations for the diagnosis and treatment of Acinetobacter meningitis.
Main Methods:
- Isolation and identification of Acinetobacter strains from CSF using BacT/Alert and API 20NE systems.
- Antibiotic susceptibility testing performed via the disc-diffusion method according to NCCLS guidelines.
- Detection of ESBLs using a two-disc synergy test.
Main Results:
- 16 Acinetobacter strains were isolated from CSF; 14 identified as Acinetobacter baumannii.
- All strains exhibited multidrug resistance, except for one A. haemolyticus strain.
- Carbapenems showed universal sensitivity; 7 strains produced ESBLs, often detected with clavulanic acid/aztreonam.
Conclusions:
- Acinetobacter meningitis requires accurate microbiological diagnosis beyond microscopy, considering its resistance patterns.
- Treatment strategies must incorporate antibiotic sensitivity testing and CSF penetration capabilities.
- A combination of antibiotic stewardship, hygiene, and infection monitoring is crucial for preventing the spread of multidrug-resistant Acinetobacter.