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Posttraumatic meningitis: bacteriology, hydrocephalus, and outcome
I Baltas1, S Tsoulfa, P Sakellariou
1Department of Neurosurgery, G. Papanikolaou Hospital, Thessaloniki, Macedonia, Greece.
Abstract:
To investigate the conditions that have developed in the treatment of posttraumatic meningitis with the use of new antibiotics, the authors studied cases with this infection retrospectively for a period of 68 months. Among 860 patients with moderate to severe head injuries, 12 (1.39%) sustained this complication. Of these, nine patients (75%) had a demonstrable basilar skull fracture and seven (58.3%) presented obvious rhinorrhea. Of these seven, four (57.1%) were treated conservatively and three (42.8%) finally underwent surgery for dural repair. The infecting agents were Gram-positive cocci (Staphylococcus haemolyticus, Staphylococcus warneri, Staphylococcus cohnii, Staphylococcus epidermidis, and Streptococcus pneumoniae) in five patients and Gram-negative bacilli in six patients (Escherichia coli in two, Klebsiella pneumoniae in two, and Acinetobacter anitratus in two). In one patient, the culture results were negative. All Gram-negative strains appeared resistant to ampicillin and third-generation cephalosporins, but sensitive to imipenem and to the quinolone ciprofloxacin. Gram-positive strains were sensitive to vancomycin. Hydrocephalus finally developed in the two patients who had received intrathecal infusions of amikacin. No other report of the relation of intrathecal infusion of antibiotics and the development of hydrocephalus was found. All patients survived, indicating that, for the present, posttraumatic meningitis is a nonfatal complication of head injury.
Insights
Posttraumatic meningitis, a complication of head injury, is nonfatal. New antibiotics like imipenem and ciprofloxacin show effectiveness against resistant Gram-negative bacteria.
Area of Science:
- Neuroscience
- Infectious Diseases
- Pharmacology
Background:
- Posttraumatic meningitis is a serious complication following head injuries.
- Understanding treatment outcomes with novel antibiotics is crucial for patient management.
Purpose of the Study:
- To evaluate the efficacy and complications of new antibiotic treatments for posttraumatic meningitis.
- To identify common pathogens and their antibiotic sensitivities in this patient cohort.
Main Methods:
- Retrospective study of 860 patients with moderate to severe head injuries over 68 months.
- Analysis of 12 cases (1.39%) who developed posttraumatic meningitis.
- Identification of causative agents and assessment of antibiotic susceptibility patterns.
Main Results:
- Gram-positive cocci and Gram-negative bacilli were the primary pathogens.
- Gram-negative strains showed resistance to ampicillin and cephalosporins but sensitivity to imipenem and ciprofloxacin.
- Gram-positive strains were sensitive to vancomycin.
- Two patients developed hydrocephalus after intrathecal amikacin infusions.
- All patients survived the infection.
Conclusions:
- Posttraumatic meningitis, while serious, is currently a nonfatal complication of head injury.
- Imipenem and ciprofloxacin are effective against resistant Gram-negative bacteria causing meningitis.
- Intrathecal amikacin may be associated with hydrocephalus development.