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Volume 43, Number 4, August 2010

Influence of Third-generation Cephalosporin Resistance on Adult In-hospital Mortality From Post-neurosurgical Bacterial Meningitis   

Chia-Jung Chang, Jung-Jr Ye, Chien-Chang Yang, Po-Yen Huang, Ping-Cherng Chiang, Ming-Hsun Lee

Received: March 10, 2009    Revised: June 10, 2009    Accepted: July 29, 2009   


Corresponding author:

Ming-Hsun Lee, Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital, 5 Fu-Shin Street, Gueishan 333, Taoyuan, Taiwan


Background and purpose: 

To investigate the clinical features, etiology and predictors of in-hospital mortality in adults with post-neurosurgical bacterial meningitis.



This retrospective analysis included 60 adult patients with culture-proven post-neurosurgical bacterial meningitis hospitalized between September 2006 and August 2008.



Of the 60 patients, 88.3% had monomicrobial infection and 11.7% had mixed infection. The mean duration from the first neurosurgical procedure to the diagnosis of meningitis was 21 days (range, 1–134 days). The median frequency of neurosurgical procedure before meningitis was 1 (range, 1–5). A total of 69 isolates were identified from the cerebrospinal fluid, the most common pathogens were Gram-negative bacilli (43, 62.3%), followed by Gram-positive bacteria (24, 34.8%). The three most common Gram-negative bacilli were Serratia marcescens (7, 10.1%), Klebsiella pneumoniae (6, 8.7%), and Enterobacter cloacae (4, 5.8%). Pseudomonas aeruginosa and Acinetobacter baumannii isolates comprised less than 3%. Notably, glucose non-fermenting Gram-negative bacilli other than Acinetobacter and Pseudomonas spp. accounted for 11.6% of the total. Of the Gram-negative bacilli, resistance rates to the third-generation cephalosporins, ceftriaxone and ceftazidime, were 58.1% and 34.9%, respectively. The two most common Gram-positive pathogens were Staphylococcus aureus (10, 14.5%) and coagulase-negative staphylococci (including S. epidermidis) (10, 14.5%). The in-hospital mortality rate was 15.0%, which was significantly related to Gram-negative bacilli resistant to third-generation cephalosporins in multivariate analysis (adjusted odds ratio = 33.65; p = 0.047).


These findings may portend the spread of serious resistance to third-generation cephalosporins in nosocomial Gram-negative bacilli throughout the neurosurgical units, suggestive of the need to reassess the empirical use of third-generation cephalosporins in post-neurosurgical bacterial meningitis.


Key words:

 bacterial meningitis  ,  Gram-negative bacilli  ,  post-neurosurgical