Postoperative Meningitis Caused by Multidrug-Resistant Pathogens: A Case Report

Central nervous system infections are recognized as a serious complication in patients, particularly in those with external ventricular drains. Here, we report the case of a 76-year-old woman who presented with nausea, dizziness, and cerebral discomfort following meningioma resection surgery and subsequent external ventricular drain placement. Perioperative ceftriaxone was initiated. During her stay in the intensive care unit, the patient developed a loss of consciousness and respiratory distress, necessitating reoperation for ventricular drain placement. Initial cerebrospinal fluid (CSF) analysis revealed no white blood cells or bacteria, and the first CSF culture showed no growth. However, the patient's respiratory failure and oxygen desaturation progressively worsened. Escherichia coli was detected in deep tracheal aspirate culture, prompting a revision of treatment to piperacillin-tazobactam. Subsequently, Gram-negative coccobacilli were detected in the CSF, which was inoculated into blood culture bottles, yielding a positive signal within three hours. Multiplex PCR analysis using the Biofire BCID-2 sepsis panel identified Acinetobacter baumannii and Klebsiella pneumoniae, both harboring carbapenemase genes (OXA-48 and CTX-M in A. baumannii, KPC in K. pneumoniae). Identification and antibiotic susceptibility testing were performed using Vitek-2 and conventional disc diffusion methods. Urgent intraventricular colistin, in combination with meropenem administered by prolonged infusion, was initiated. This antibiotic regimen successfully eradicated the bacteria from the CSF. Despite microbiological clearance, the patient succumbed to systemic hypotension, worsening oxygen saturation, and uncontrolled complications of diabetes. This case underscores the critical risk of central nervous system infections caused by A. baumannii and K. pneumoniae in patients undergoing neurosurgical procedures, particularly those involving external ventricular drains. Moreover, it highlights the importance of vigilant postoperative monitoring and a multidisciplinary approach in managing complex complications following posterior fossa meningioma surgery.