Mortality rate in patients with nosocomial Acinetobacter meningitis from a Brazilian hospital

Tuon, Felipe Francisco; Penteado-Filho, Sergio R; Amarante, Diogo; Andrade, Marcio A; Borba, Luis A

doi:10.1016/S1413-8670(10)70090-8

Article information

Statistics

Abstract

Background

The mortality rate due to Acinetobacter baumannii nosocomial meningitis (ANM) is high.

Objective

The aim of this study was to evaluate the factors that have influence over the outcomes in ANM patients.

Methods

A retrospective analysis of 22 cases of ANM was conducted in a hospital with high incidence of multidrug resistance.

Results

The mean age of patients was 43 years (21 to 91) and 54.5% were male. All ANM cases occurred within 60 days of admission and the mean duration of illness was of 18.2 days. All cases were associated with previous neurosurgical procedures: elective surgery (27.2%), external shunt (54.4%) and emergency surgery due to trauma (18.1%). Imipenem resistance was observed in 40.9% of cases, but ampicillin/sulbactam resistance was lower (27.2%). The mortality rate of ANM patients was of 72.7%. The only risk factor associated with mortality was inappropriate therapy within five days after CSF collection. All patients who survived the meningitis episode had received appropriate therapy, in contrast to only 69.2% of those who did not survive (OR = 5.15; IC = 0.45-54.01).

Conclusions

The high mortality rate observed in our study suggests the need for aggressive empirical treatment with addition of drugs, including intrathecal therapy, where multi-resistant A. baumannii is endemic.

Keywords:

Acinetobacter

meningitis

Acinetobacter baumannii

neurosurgery

imipenem

ampicillin/ sulbactam

Full text is only aviable in PDF

References

[1.]

S. Sacar, H. Turgut, S. Toprak, et al.

A retrospective study of central nervous system shunt infections diagnosed in a university hospital during a 4-year period.

BMC Infect Dis, 6 (2006), pp. 43

http://dx.doi.org/10.1186/1471-2334-6-43 | Medline

[2.]

I. Erdem, T. Hakan, N. Ceran, et al.

Clinical features, laboratory data, management and the risk factors that affect the mortality in patients with postoperative meningitis.

Neurol India, 56 (2008), pp. 433-437

Medline

[3.]

A. Streharova, J. Benca, K. Holeckova, et al.

Comparison of postsurgical and community acquired bacterial meningitis – analysis of 372 cases within a nationwide survey.

Neuro Endocrinol Lett, 28 (2007), pp. 7-9

Medline

[4.]

M. Huttova, P.F. Freybergh, B. Rudinsky, et al.

Postsurgical meningitis caused by Acinetobacter baumannii associated with high mortality.

Neuro Endocrinol Lett, 28 (2007), pp. 15-16

Medline

[5.]

G. Metan, E. Alp, B. Aygen, B. Sumerkan.

Acinetobacter baumannii meningitis in post-neurosurgical patients: clinical outcome and impact of carbapenem resistance.

J Antimicrob Chemother, 60 (2007), pp. 197-199

http://dx.doi.org/10.1093/jac/dkm181 | Medline

[6.]

CLSI. Performance Standards for Antimicrobial Susceptibility Testing; Twentieth Informational Supplement. CLSI documento M100-S20. Wayne, PA. Clinical and Laboratory Standards Institute 2010.

[7.]

G.A. Rodriguez, A. Blanco, V. Asensi, et al.

Multidrug-resistant Acinetobacter meningitis in neurosurgical patients with intraventricular catheters: assessment of different treatments.

J Antimicrob Chemother, 61 (2008), pp. 908-913

http://dx.doi.org/10.1093/jac/dkn018 | Medline

[8.]

S.F. Chen, W.N. Chang, C.H. Lu, et al.

Adult Acinetobacter meningitis and its comparison with non-Acinetobacter gramnegative bacterial meningitis.

Acta Neurol Taiwan, 14 (2005), pp. 131-137

Medline

[9.]

M.E. Falagas, P. Kopterides, Siempos II.

Attributable mortality of Acinetobacter baumannii infection among critically ill patients.

Clin Infect Dis, 43 (2006), pp. 389-390

http://dx.doi.org/10.1086/505599 | Medline

[10.]

A.S. Levin.

Treatment of Acinetobacter spp infections.

Expert Opin Pharmacother, 4 (2003), pp. 1289-1296

http://dx.doi.org/10.1517/14656566.4.8.1289 | Medline

[11.]

A.O. Reis, D.A. Luz, M.C. Tognim, H.S. Sader, A.C. Gales.

Polymyxin- resistant Acinetobacter spp. isolates: what is next?.

Emerg Infect Dis, 9 (2003), pp. 1025-1027

http://dx.doi.org/10.3201/eid0908.030052 | Medline

[12.]

M.E. Falagas, I.A. Bliziotis, V.H. Tam.

Intraventricular or intrathecal use of polymyxins in patients with Gram-negative meningitis: a systematic review of the available evidence.

Int J Antimicrob Agents, 29 (2007), pp. 9-25

http://dx.doi.org/10.1016/j.ijantimicag.2006.08.024 | Medline

[13.]

C.H. Lee, Y.F. Tang, L.H. Su, C.C. Chien, J.W. Liu.

Antimicrobial effects of varied combinations of meropenem, sulbactam, and colistin on a multidrug-resistant Acinetobacter baumannii isolate that caused meningitis and bacteremia.

Microb Drug Resist, 14 (2008), pp. 233-237

http://dx.doi.org/10.1089/mdr.2008.0840 | Medline

[14.]

E.J. Fulnecky, D. Wright, W.M. Scheld, L. Kanawati, S. Shoham.

Amikacin and colistin for treatment of Acinetobacter baumannii meningitis.

J Infect, 51 (2005), pp. e249-e251

http://dx.doi.org/10.1016/j.jinf.2005.04.003 | Medline

[15.]

T. Gleeson, K. Petersen, J. Mascola.

Successful treatment of Acinetobacter meningitis with meropenem and rifampicin.

J Antimicrob Chemother, 56 (2005), pp. 602-603

http://dx.doi.org/10.1093/jac/dki274 | Medline