Post-surgical enterococcal meningitis: clinical and epidemiological study of 20 cases

Scand J Infect Dis. 2006;38(8):584-8. doi: 10.1080/00365540600606416.

Abstract

Enterococcal post-surgical meningitis is an uncommon disease. 20 episodes of nosocomial post-surgical enterococcal meningitis diagnosed between 1994 and 2003 were retrospectively studied. During the period of study 20 cases of post-surgical enterococcal meningitis (60% female, mean age 55+/-18 y, range 16-78 y) were reviewed. The mean time between admission at the hospital and surgery was 26 (SD = 15) d (range 7-61 d). The most frequent underlying diseases were: intracerebral haemorrhage (55%), brain neoplasms (25%), head trauma (15%) and hydrocephalus (5%). 11 patients had previously received antibiotic treatment. The isolates identified were Enterococcus faecalis (n = 18) (90%), E. faecium (1) and E. durans (1). 11 patients had polymicrobial infections. The treatment most frequently used was vancomycin alone or with other antibiotics (11). In 5 patients intrathecal vancomycin (20 mg/d) was also added. The mortality rate was not different in intrathecally treated patients. Cerebrospinal fluid (CSF) devices were removed in 8 patients. Four patients died due to the infection. Mortality was significantly associated with lack of removal of the CSF devices (p = 0.04). Enterococcal spp. are a cause of nosocomial meningitis associated with neurosurgical procedures and the presence of neurological devices.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Cross Infection / cerebrospinal fluid
  • Cross Infection / epidemiology*
  • Cross Infection / microbiology*
  • Enterococcus / growth & development
  • Enterococcus / isolation & purification*
  • Female
  • Humans
  • Male
  • Meningitis, Bacterial / cerebrospinal fluid
  • Meningitis, Bacterial / epidemiology*
  • Meningitis, Bacterial / microbiology
  • Middle Aged
  • Postoperative Complications / cerebrospinal fluid
  • Postoperative Complications / epidemiology*
  • Postoperative Complications / microbiology*
  • Retrospective Studies