M.P Almiroudi1, E. Paramithiotou1, M. Rizos1, G. Dimopoulos1
Address for correspondence: Prof. G. Dimopoulos
12462 Chalandri Athens
e-mail : firstname.lastname@example.org
Nosocomial bacterial meningitis (NBM) is related to neurosurgical procedures, traumatic brain injury, or rarely to systemic infection. The purpose of the present study was to analyze the cases of NBM treated in the ICU of University Hospital ATTIKON.
During a two-year period through a prospective onservetional study in the ICU 14(100%) non-immunocompromised patients (mean age 50±20y, mean APACHE II score 19±6) with CNS infection were recruited. The diagnostic criteria for NBM were fever with or without septic shock, new onset seizures, a positive CSF culture, CSF pleocytosis and the exclusion of other sites of infection. CSF analysis, Gram stain, CSF culture and blood cultures were performed in all patients. From the 14(100%) patients, 4 had traumatic brain injury, 4 spontaneous intracerebral hemorrhage,
4 intracerebral hemorrhage due to aneurysm rupture and 2 hydrocephalus. In 7/14 patients craniectomy was performed, while an external ventricular drain (EVD) was inserted in 8/14 patients and an intraparenchymal catheter for intracranial pressure (ICP) monitoring in 4/14. A positive CSF culture has been detected in 5/14 (36%). Isolated microorganisms were Multidrug Resistant Klebsiella pneumoniae and Acinetobacter baumanii. In 2/14 patients the EVD/ICP catheter tip culture was positive for Klebsiella pneumoniae and Acinetobacter baumanii. Differences in CRP, procalcitonin, WBC and CSF parameters in pts with positive and negative CSF cultures were not statistically significant. All patients received empirically wide spectrum antibiotics and 2/14 received intraventricular antibiotics combined with intravenous therapy. Mortality was 14% (2/14).
In conclusion, the clinical signs and laboratory/radiologic findings of NBM in the ICU are not specific. CSF cultures may be negative due to previous antibiotic administration. The early adequate and appropriate antibiotic therapy is crucial, while intraventricular/intrathecal administration of antibiotics may be necessary.