CLINICAL STUDIES
NOSOCOMIAL BACTERIAL MENINGITIS (NBM) IN THE ICU
M.P Almiroudi1, E. Paramithiotou1,
M. Rizos1, G. Dimopoulos1
1 Intensive Care Unit ,
University Hospital Attikon, Athens
National and Kapodistrian University of Athens
Address for correspondence: Prof. G. Dimopoulos
Intensive Care Unit , University Hospital Attikon Athens
National and Kapodistrian University of Athens
Rimini 1
12462 Chalandri Athens
GSM
+30.6944.756565
e-mail : gdimop@med.uoa.gr
Abstract
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.