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Imipenem resistance in a case of AIDS with relapsing Pseudomonas meningitis
Abstract:
We describe an AIDS patient who had a recurrence of Pseudomonas meningitis to illustrate three points. First, the use of sulfamethoxazole-trimethoprim in AIDS patients for prophylaxis of Pneumocystis carinii pneumonia may cause the various body sites to be colonized with resistant species such as P aeruginosa. Second, Pseudomonas meningitis can recur in a patient with AIDS after a month of appropriate therapy. Finally, imipenem is a poor choice for Pseudomonas meningitis, even when alternative therapies appear much less attractive. High doses of imipenem should not be used for fear of seizures, and lower doses only produce resistant organisms in the CSF.
Insights
Sulfamethoxazole-trimethoprim prophylaxis in AIDS patients may lead to resistant Pseudomonas aeruginosa infections. Recurrent Pseudomonas meningitis is possible even after treatment, and imipenem is an ineffective choice for this condition.
Area of Science:
- Infectious Diseases
- Immunocompromised Hosts
- Clinical Microbiology
Background:
- Acquired Immunodeficiency Syndrome (AIDS) patients are susceptible to opportunistic infections.
- Prophylaxis for Pneumocystis carinii pneumonia (PCP) is common in AIDS patients.
- Pseudomonas aeruginosa is an opportunistic pathogen that can cause serious infections.
Observation:
- A case of recurrent Pseudomonas meningitis in an AIDS patient is presented.
- The patient was receiving sulfamethoxazole-trimethoprim for PCP prophylaxis.
- Pseudomonas aeruginosa was isolated from cerebrospinal fluid (CSF) during recurrence.
Findings:
- Sulfamethoxazole-trimethoprim prophylaxis may promote colonization with drug-resistant bacteria like Pseudomonas aeruginosa.
- Pseudomonas meningitis recurred in the AIDS patient despite a month of appropriate therapy.
- Imipenem was found to be an ineffective treatment for Pseudomonas meningitis, with high doses risking seizures and lower doses fostering resistance in CSF.
Implications:
- Clinicians should consider the potential for resistant organisms when using prophylactic antibiotics in AIDS patients.
- Recurrent bacterial meningitis can occur in immunocompromised individuals even with treatment.
- Treatment guidelines for Pseudomonas meningitis in AIDS patients may need revision, particularly regarding the use of imipenem.