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[Post-traumatic bacterial meningitis]
U Kluba-Wojewoda1, M Krupa, M Moskała
1Katedra i Klinka Chorób Zakaźnych Collegium Medicum Uniwersytetu Jagiellońskiego w Krakowie.
Abstract:
10 patients with posttraumatic bacterial meningitis were treated in the Department of Infectious Diseases of the Jagielloniam University--Collegium Medicum during the period of 63 months. Traffic accidents were responsible for 80% of all cases of trauma. The most common place of injury was the base of anterior cranial fossa. Infecting agent was established in 8 cases. Gram-positive aerobic cocci (Streptococcus pneumoniae, Enterococcus faecalis, and Enterococcus spp.) were found in 4 patients, Gram-negative aerobic cocci (Neisseria meningitidis) in 2 patients, and Gram-negative aerobic rods (Acinetobacter baumanii, Pseudomonas aeruginosa, Klebsiella spp, Escherichia coli) in 3 patients. Streptococcus pneumoniae was still highly sensitive to penicillin, ampicillin and cefotaxime. Enterococcus faecalis and Enterococcus spp. were sensitive to vancomycin and teicoplanin. Neisseria meningitidis was sensitive to penicillin, cefotaxime, amoxicillin/clavulonate. Gram negative aerobic rods were sensitive to third-generation cephalosporins, carbapenems and aminoglycosides. Among 10 patients treated for posttraumatic bacterial meningitis 1 patient died and in 1 preserved vegetative state was diagnosed. In 4 patients severe or moderate disabilities developed, however 4 recovered completely. 6 patients after regression of the CNS infection were qualified to neurosurgical intervention. In 3 patients reconstructive operation of the basis of anterior cranial fossa with tissue glue Beriplast P. was done, the recovery was complete. 3 patients didn't agree to surgical operation, and we don't know what has happened with them. They have not come to the control visit.
Insights
Posttraumatic bacterial meningitis, often from traffic accidents, requires prompt treatment. Surgical intervention for cranial base injuries improved outcomes in patients with posttraumatic bacterial meningitis.
Area of Science:
- Neuroscience
- Infectious Diseases
- Trauma Surgery
Context:
- Posttraumatic bacterial meningitis is a severe complication following head injuries.
- Traffic accidents are a primary cause of traumatic brain injury leading to meningitis.
- The base of the anterior cranial fossa is a common site of injury.
Purpose:
- To analyze the treatment outcomes of posttraumatic bacterial meningitis.
- To identify common causative agents and their antibiotic sensitivities.
- To evaluate the role of neurosurgical intervention in managing complications.
Summary:
- Ten patients with posttraumatic bacterial meningitis were treated, with Gram-positive cocci, Gram-negative cocci, and Gram-negative rods identified as common pathogens.
- Antibiotic sensitivities varied, with Streptococcus pneumoniae sensitive to penicillin and cefotaxime, and Enterococcus species sensitive to vancomycin.
- While mortality and severe disabilities occurred, 40% of patients recovered completely, and surgical repair of cranial base defects showed promising results.
Impact:
- Highlights the significant morbidity and mortality associated with posttraumatic bacterial meningitis.
- Provides data on antibiotic resistance patterns for common pathogens.
- Suggests neurosurgical intervention may improve outcomes in select cases of posttraumatic meningitis with cranial base defects.