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

Parodi, Stephen; Lechner, Arno; Osih, Regina; Vespa, Paul; Pegues, David
July 2003
Clinical Infectious Diseases;7/15/2003, Vol. 37 Issue 2, p159
Academic Journal
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.


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