L-638. Antimicrobial Management Of Adult Bacterial Meningitis
Session: Poster Session: New Issues With Central Nervous System Infections
Saturday, October 25, 2008: 12:00 AM
Room: Hall C
Background: We prospectively evaluated antimicrobial management of adult bacterial meningitis and compliance with Dutch guidelines. Methods: From Mar 2006 to Apr 2008, all Dutch patients >16 yrs with community-acquired bacterial meningitis, confirmed by cerebrospinal fluid cultures, were prospectively evaluated. Patients were categorized according to age and risk factors (Table). Microbiological coverage for Neisseria meningitidis (NM), Streptococcus pneumoniae (SP) and Haemophilus influenzae (HI) was based on antibiotic susceptibility testing. For other isolates, coverage was based on antimicrobial spectra of antibiotic agents. Results: 331 patients were included; SP was the most common causative organism (71%). 1/234 SP strains was penicillin-resistant and 2/13 HI strains were ß-lactamase positive; all 47 NM strains were penicillin-sensitive. The most commonly prescribed initial antibiotic regimen was monotherapy penicillin or amoxicillin (42%) and therapy was stepped down to this regimen after Gram or culture results in an additional 31% of patients. Antimicrobial therapy was compliant with Dutch guidelines in 37% of patients and microbiologically adequate in 100% of these patients. In patients with non-compliant antibiotic treatment, coverage was microbiologically adequate in 98% of patients. Patients not adequately treated were infected with HI, Pseudomonas aeruginosa, Klebsiella pneumoniae and Escherichia coli. Conclusions: 1. Antibiotic resistance among isolates causing meningitis in the Netherlands is still low. 2. Treatment is often non-compliant with Dutch guidelines. 3. The microbiological coverage for Dutch patients who are treated in compliance with Dutch guidelines is complete (100%).
Initial antimicrobial therapy in 331 adults with bacterial meningitis.
Category 1: Age 17-60 years without risk factors (N=143) Category 2: Age >60 years without risk factors (N=96) Category 3: Age >16 years and risk factor present (alcohol abuse, altered immune status, recent head injury or cerebrospinal fluid leak) (N=92).
Dutch guidelines recommendation for category (*)Amoxicillin/penicillinAmoxicillin/penicillin + 3rd- generation cephalosporinAmoxicillin/penicillin + 3rd- generation cephalosporin
Amoxicillin/penicillin64/143 (45%) *44/96 (46%)31/92 (34%)
Amoxicillin/penicillin + 3rd- generation cephalosporin29/143 (20%)27/96 (28%) *31/92 (34%) *
3rd- generation cephalosporin41/143 (29%)18/96 (19%)19/92 (21%)
Vancomycin-based regimen1/143 (1%)-1/92 (1%)
Other antibiotic regimen7/143 (5%)7/96 (7%)10/92 (11%)
Microbiologically adequate143/143 (100%)94/94 (98%)90/92 (98%)
Diederik van de Beek, MD, PhD1, Jan de Gans, MD, PhD1, Lodewijk Spanjaard, Ph D2, Matthijs Brouwer, MD2, Sebastiaan Heckenberg, MD1 and  S. G. B. Heckenberg, None., (1)Academic Medical Center, Amsterdam, Netherlands, (2)Academic Medical Center