Nosocomial Enterobacter Meningitis: Risk Factors, Management, and Treatment Outcomes

• Published in: Clinical infectious diseases 2003-07, Vol.37 (2), p.159-166
• Main Authors: Parodi, Stephen, Lechner, Arno, Osih, Regina, Vespa, Paul, Pegues, David
• Format: Article
• Language: English
• Subjects: Adult; Aged; Anti-Bacterial Agents - therapeutic use; Antimicrobials; Bacterial diseases; Bacterial diseases of the nervous system. Bacterial myositis; Bacterial meningitis; Biological and medical sciences; Cephalosporins; Cross Infection - cerebrospinal fluid; Cross Infection - drug therapy; Cross Infection - epidemiology; Drains; Enterobacter; Enterobacter - drug effects; Enterobacter - isolation & purification; Enterobacteriaceae Infections - cerebrospinal fluid; Enterobacteriaceae Infections - drug therapy; Enterobacteriaceae Infections - epidemiology; Female; Human bacterial diseases; Humans; Infections; Infectious diseases; Major Articles; Male; Median nerve; Medical sciences; Meningitis; Meningitis, Bacterial - cerebrospinal fluid; Meningitis, Bacterial - drug therapy; Meningitis, Bacterial - epidemiology; Middle Aged; Multivariate Analysis; Predisposing factors; Risk Factors; Statistical median; Treatment Outcome
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1086/375596

Enterobacter species are increasingly a cause of nosocomial meningitis among neurosurgery patients, but risk factors for these infections are not well defined. A review of all adult patients hospitalized at the University of California-Los Angeles (UCLA) Medical Center during an 8-year period identified 15 postneurosurgical cases of Enterobacter meningitis (EM). Cure was achieved in 14 cases (93%), and efficacy was similar for carbapenem- and cephalosporin-based treatment. A matched case-control study comparing 26 controls with 13 case patients hospitalized exclusively at the UCLA Medical Center found that external cerebrospinal fluid (CSF) drainage devices (odds ratio [OR], 21.8; P = .001), isolation of Enterobacter species from a non-CSF culture (OR, 24.6; P = .002), and prolonged administration of antimicrobial drugs before the diagnosis of meningitis that were inactive in vitro against Enterobacter species (OR, 13.3; P = .008) were independent risk factors for EM. Despite favorable treatment outcomes, EM is a serious infection associated with Enterobacter species colonization or infection at other surgical sites, with selective antimicrobial pressure, and with invasive CNS devices.