Proceeding | By By Lee et. al

Introduction:

Healthcare-associated meningitis or ventriculitis (HCAMV) is a serious complication of neurosurgical procedures.

 

Methods:

All adult patients aged ≥ 18 years old admitted to our hospital who developed microbiologically confirmed HCAMV following neurosurgical procedure were retrospectively included from July 2012 to August 2017. Patients were identified from the microbiology laboratory database. Data regarding aetiological agents, antibiotic susceptibility patterns and antibiotic prescribing patterns were collected.

 

Results:

Fifty-two patients were included. Gram-negative bacilli (GNB) were the most common cause of HCAMV (n=32; 62%). Acinetobacter baumanii (AB) was the predominant GNB identified (21/32; 66%). Carbapenem-resistant AB (CRAB) accounted for the majority of the AB isolates (15/21; 71%) and was the most common aetiological agent overall (29%). The most common Gram-positive bacteria isolated were coagulase-negative Staphylococci (CoNS) (n=13) and Staphylococcus aureus (SA) (n=6). The majority of the CoNS and SA were methicillin-resistant (CoNS=11/13, 85%; SA=4/6, 67%). All the Staphylococcus isolates were susceptible to vancomycin. Forty-two patients were given empiric antibiotics. The most commonly prescribed empiric antibiotics were meropenem (n=13; 31%), vancomycin (n=10; 24%) and ceftriaxone (n=10; 24%). Only 9 patients (21%) received an empiric antibiotic that was active against the recovered organisms. None of the empiric antibiotics given were active against CRAB.

 

Conclusion:

CRAB was the most common aetiological agent of HCAMV in our cohort. However, the commonly prescribed empiric antibiotics for this infection at our hospital are ineffective against it. Current treatment guidelines for HCAMV which recommend vancomycin plus an anti-pseudomonal beta-lactam as empirical therapy may not be appropriate in our setting.