ABSTRACT
BACKGROUND AND OBJECTIVE: In recent years, meningitis caused by methicillin-resistant S. aureus has increased. This study was undertaken to compare the clinical characteristics and prognosis of methicillin-resistant S. aureus (MRSA) postneurosurgical meningitis and methicillin-sensible S. aureus (MSSA) postneurosurgical meningitis. PATIENTS AND METHODS: Twenty-five episodes of postneurosurgical meningitis due to S. aureus (13 methicillin-resistant strains) seen during a ten-year period were retrospectively reviewed. RESULTS: Most common underlying diseases were: intracerebral hemorrhage (50% of MRSA patients and 46% of MSSA patients) and neoplasm (53% of MRSA patients and 33% of MSSA patients). Eleven patients (6 of them with MRSA infection) had received antibiotic treatment previously. Thirteen patients were carriers of intraventricular catheters (8 with MRSA infection), 5 wore a ventriculoperitoneal shunt (4 with infections by MSSA), 5 cases had a CSF leakage (4 with infections by MRSA), and one patient with infection by MSSA wore an epidural catheter. Fifteen patients were cured (7 with MRSA infection), and 8 died due to the infection (27% with MSSA infection and 38% with MRSA infection). CONCLUSIONS: The prognosis of postneurosurgical meningitis by S. aureus does not depend on the presence of resistance to methicillin. Nowadays, the intravenous administration of vancomycin is the treatment of choice in MRSA meningitis.
Subject(s)
Cross Infection/drug therapy , Cross Infection/epidemiology , Meningitis, Bacterial/drug therapy , Meningitis, Bacterial/epidemiology , Neurosurgical Procedures , Staphylococcal Infections/drug therapy , Staphylococcal Infections/epidemiology , Surgical Wound Infection/drug therapy , Surgical Wound Infection/epidemiology , Female , Humans , Male , Methicillin Resistance , Middle Aged , Prognosis , Retrospective Studies , Staphylococcus aureus/drug effectsABSTRACT
FUNDAMENTO Y OBJETIVO: En los últimos años se ha descrito con frecuencia creciente casos de meningitis producidas por cepas de Staphylococcus aureus resistentes ameticilina (SARM). Se estudian las características diferenciales tanto clínicas como pronósticas de los pacientes diagnosticados de meningitis posquirúrgicas debidas a SARM y las debidas a Staphylococcus aureus sensibles a meticilina (SASM). PACIENTES Y MÉTODOS: Estudio retrospectivo, de 1992 a 2002, de 25 episodios de meningitis nosocomial posquirúrgica por Staphylococcus aureus, de los que 13 fueron por SARM. RESULTADOS: Las enfermedades subyacentes más frecuentemente diagnosticadas fueron la hemorragia cerebral (el 50% de los pacientes con SARM y el 46% de los pacientes con SASM) y las neoplasias (el 53% de los pacientes con SARM y el 33% de los pacientes con SASM). En 11 enfermos se recogía el antecedentede tratamiento antibiótico previo (6 de ellos con infección por SARM). Trece de los pacientes eran portadores de catéteres intraventriculares (8 con infecciones por SARM), 5 portaban una derivación ventrículo peritoneal (4 con infecciones por SASM), otros 5 casos presentaban una fístula de líquido cefalorraquídeo (4con infecciones por SARM) y 1 paciente con infección por SASM tenía un catéter epidural. En 15 casos se produjo la curación (7 con SARM), 1 enfermo de cada grupo recidivó y 8 fallecieron a consecuencia directa de la infección (el 27% de los pacientes con SASM yel 38% de los enfermos con SARM). CONCLUSIONES: La presencia de resistencia a la meticilina no parece empeorar el pronóstico de los pacientes con meningitis posquirúrgica por Staphylococcus aureus. Aunque la vancomicina permanece como tratamiento de elección, es posible que nuevos antibióticos de reciente aparición cambien en el futuro el tratamiento de esta entidad
BACKGROUND AND OBJECTIVE: In recent years, meningitiscaused by methicillin-resistant S. aureus has increased. This study was undertaken to compare the clinical characteristics and prognosis of methicillin-resistantS. aureus (MRSA) postneuro surgical meningitis and methicillin-sensible S. aureus (MSSA) postneuro surgical meningitis. PATIENTS AND METHODS: Twenty-five episodes of postneurosurgical meningitis due to S. aureus (13 methicillin-resistant strains) seen during a ten-year period were retrospectively reviewed. RESULTS: Most common underlying diseases were: intracerebral hemorrhage (50% of MRSA patients and46% of MSSA patients) and neoplasm (53% of MRSA patients and 33% of MSSA patients). Eleven patients(6 of them with MRSA infection) had received antibiotic treatment previously. Thirteen patients were carriersof intraventricular catheters (8 with MRSA infection),5 wore a ventriculoperitoneal shunt (4 with infections by MSSA), 5 cases had a CSF leakage (4 with infections by MRSA), and one patient with infection by MSSA wore an epidural catheter. Fiftteen patients were cured (7 with MRSA infection), and 8 died due to the infection (27% with MSSA infection and 38% with MRSA infection). CONCLUSIONS: The prognosis of postneuro surgical meningitis by S. aureus does not depend on the presence of resistance to methicillin. Nowadays, the intravenous administration of vancomycin is the treatment of choice in MRSA meningitis
Subject(s)
Male , Female , Humans , Methicillin/pharmacology , Meningitis/epidemiology , Cross Infection/epidemiology , Staphylococcus aureus/pathogenicity , Postoperative Complications/microbiology , Retrospective Studies , Staphylococcus aureus , Methicillin Resistance , Vancomycin/therapeutic use , Drug Resistance, Multiple, BacterialSubject(s)
Anti-HIV Agents/adverse effects , Chemical and Drug Induced Liver Injury/etiology , HIV Infections/complications , HIV-1 , Hepatitis C, Chronic/complications , Liver/drug effects , Nevirapine/adverse effects , Adult , Chemical and Drug Induced Liver Injury/epidemiology , Female , HIV Infections/blood , HIV Infections/drug therapy , Hepatitis C, Chronic/blood , Hepatitis C, Chronic/epidemiology , Humans , Liver Function Tests , Male , Viral LoadABSTRACT
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