505. Transition of Antimicrobial Susceptibilities of Nosocomial Acinetobacter baumannii Meningitis
Session: Poster Session: Hospital-acquired and Transplant Infections
Friday, October 30, 2009: 12:00 AM
Room: Poster Hall A
Background: Multi-drug resistant (MDR) Acinetobacter baumannii (AB) has become a growing health problem throughout the world. Nosocomial meningitis is an uncommon complication of neurosurgical procedures, and Gram-negative meningitis rarely occurs. Recently we experienced several cases of meningitis by MDR-AB. The MDR-AB meningitis has a serious therapeutic problem due to the limited antibiotics into the CSF. The aim of this study was to assess the epidemiology of post-neurosurgical meningitis and the clinical characteristics and outcome of AB meningitis.
Methods: All patients with culture proven meningitis diagnosed between 2003 and 2008 were retrospectively reviewed. Cases known to have diagnosed AB meningitis were reviewed in connection with risk factors, treatment options and clinical outcomes.
Results: During the period of this study, 44.9% were identified as nosocomial meningitis out of total 118 cases. Coagulase negative staphylococcus (35.8%) was the most common cause of post-neurosurgical meningitis, followed by methicillin resistant Staphylococcus aureus (22.6%), and AB (13.2%) respectively. All cases of AB meningitis were related with prior neurosurgical procedures. Mean age of the cases was 44.3 (range 3-74). The mean duration of development of infection was 15.7 days (range 4-31) after surgery. Interestingly, while AB cases between 2003 and 2006 were all carbapenem-sensitive, other cases were all carbapenem-resistant. The attributable mortality of AB meningitis (42.9%) was still high despite of antimicrobial treatment. The clinical characteristics, risk factors, and mortality of carbapenem-sensitive (50%) and carbapenem-resistant cases (33.3%) showed no significant differences.
Conclusion: Until now, AB has been a rare cause of nosocomial meningitis. Recently, however, the prevalence in post-neurosurgical meningitis is increasing in our hospital. Multi-drug resistance for many antibiotics including carbapenems was found over the last two years. Choosing appropriate empirical antibiotics is challenging and it must be guided by an awareness of the frequency of pathogens and the incidence of resistant strains.
Misuk Lee, MD, PhD1, Song Mi Moon, MD1 and  S. Moon, None..
M. Lee, None., (1)Kyung Hee Medical Center, Seoul, Korea, Republic of