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Updated: Jan 27, 2026
Isolating Central Nervous System Tissues and Associated Meninges for the Downstream Analysis of Immune cells
Published on: May 19, 2020
Enterococcal Meningitis/Ventriculitis: A Tertiary Care Experience
Iffat Khanum1, Sana Anwar2, Aisha Farooque1
1Department of Medicine, Liaquat National Hospital and Medical College, Karachi, Pakistan.
Context:
Enterococcal meningitis is very rare among bacterial meningitis and has variable clinical outcomes.
Aims:
The purpose of the current study is to evaluate clinical features, therapeutic options with susceptibility profile, and outcomes of enterococcal meningitis in a tertiary care hospital.
Settings And Design:
We retrospectively reviewed medical records of all patients with enterococcal meningitis over the periods of 4 years.
Subjects And Methods:
The clinical and laboratory data of all patients with enterococcal meningitis were evaluated between 2013 and 2016.
Results:
Six cases of enterococcal meningitis were found (three infant and three adults). All patients developed meningitis after neurosurgical procedures, and majority of patients (four out of six) had central nervous system (CNS) devices in situ at the time of development of meningitis. The causative organism isolated from cerebrospinal fluid (CSF) culture of all patients was Enterococcus species only. All Enterococcus spp. were resistant to ampicillin, Amoxicillin-clavulanate, and oxytetracycline and two isolates were also resistant to vancomycin. Four patients with vancomycin-sensitive Enterococcus spp. were treated with vancomycin alone for mean periods of 18 days (14-21 days). One patient with vancomycin-resistant Enterococcus (VRE) meningitis was treated with linezolid alone, and another one requires combination with rifampicin to achieve microbiological clearance of CSF. CNS devices were removed in all patients. No mortality was reported in current case series.
Conclusions:
Enterococcal meningitis is very uncommon, mostly associated with neurosurgical intervention. Early treatment is associated with favorable outcomes. Removal of CNS devices is recommended to achieve a clinical cure.
Insights
Enterococcal meningitis, a rare bacterial infection often linked to neurosurgery, requires prompt treatment and removal of central nervous system devices for favorable outcomes. Early intervention is key to managing this uncommon condition.
Area of Science:
- Infectious Diseases
- Neurology
- Microbiology
Background:
- Enterococcal meningitis is an exceedingly rare form of bacterial meningitis.
- Clinical outcomes for enterococcal meningitis are highly variable.
- This condition is infrequently encountered in clinical practice.
Purpose of the Study:
- To investigate the clinical characteristics of enterococcal meningitis.
- To analyze therapeutic strategies and antimicrobial susceptibility profiles.
- To determine patient outcomes in a tertiary care setting.
Main Methods:
- Retrospective review of medical records over a four-year period (2013-2016).
- Inclusion of all patients diagnosed with enterococcal meningitis.
- Evaluation of clinical and laboratory data.
Main Results:
- Six cases identified (three infants, three adults), all post-neurosurgical procedures.
- Four patients had existing central nervous system (CNS) devices.
- Predominant resistance to ampicillin, amoxicillin-clavulanate, and oxytetracycline; two isolates resistant to vancomycin.
- Vancomycin used for sensitive cases; linezolid (with or without rifampicin) for vancomycin-resistant enterococcal (VRE) meningitis.
- CNS device removal performed in all cases; no mortality observed.
Conclusions:
- Enterococcal meningitis is uncommon and frequently associated with neurosurgical interventions.
- Early and appropriate treatment, alongside CNS device removal, is crucial for successful clinical outcomes.
- This study highlights the importance of antimicrobial stewardship and device management in managing enterococcal meningitis.
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