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Nosocomial meningitis due to Acinetobacter calcoaceticus in 10 children after ventriculoperitoneal shunt insertion
76
Letters to the Editor
Table 1 Pairwise t-test: Significant differences in accumulation of RP 62 A in relation to the tested biomaterial Material
Separate t-value
Degrees of freedom
Variance P-value
Steel versus: pmma PMMA polyethylene chrome cobalt titanium alloy ceramic Chrome cobalt versus PMMA PMMA versus ceramic
10·2 3·9 –2·1 1·16 0·61 12·99 –11·93
7 4 6 4 4 5 4
<0·0001 significant 0·015 0·0758 0·3046 0·5733 <0·0001 significant 0·0003 significant
D.P. König* J.M. Schierholz† C.H. Bertram*
*Department of Orthopaedic Surgery, Cologne University, Germany, †Department of Medical Microbiology and Hygiene, Cologne University, Germany
References 1. Blom AW, Bowker KE, Wooton M, MacGowan AP, Smith EJ, Bannister GC. Contamination of wounds by direct inoculation in total hip arthroplasty. J Hosp Inf 1998; 40:79–81. 2. Delmi M, Vaudaux PE, Descouts P, Lew PD, Vasey H. Role of fibronectin on staphylococcal adherence to metallic surfaces used as models of orthopaedic devices. In: Wadstöm T, Eliassin I, Holder I, Ljungh A. Wound and biomaterial-associated infections. Springer Verlag New York 1990; 349–351. 3. Oga M, Sugioka Y, Hobgood CD, Gristina AG, Myrvik QN. Surgical biomaterials and differential colonization by Staphylococcus epidermidis. Biomat 1988; 9:285–289. 4. Christensen GD, Simpson WA, Bisno AL, Beachey EH. Adherence of slime producing strains of Staphylococcus epidermidis to smooth surfaces. Infect Immun 1982; 37:318–326. 5. Schumacher-Perdreau F, Heilmann C, Peters G, Götz F, Pulverer G. Comparative analysis of a biofilmforming Staphylococcus epidermidis strain and its accumulation-negative isogenic mutant. FEMS Microbiol Lett 1994; 117:71–78. 6. König DP, Perdreau-Remington F, Rütt J, Stoβberger P, Hilgers RD, Plum G. Slime production of Staphylococcus epidermidis. Increased bacterial adherence and accumulation onto pure titanium. Acta Orthop Scand 1998; 69:523–526. 7. König DP, Rütt J, Hilgers RD, Perdreau-Remington F. Staphylococcus epidermidis colonisation of biomaterials used for orthopedic implants. Book of Abstracts. SIROT 1996 Amsterdam.
© 2000 The Hospital Infection Society
Article no. jhin.1999.0641, available online at http://www.idealibrary.com on
Nosocomial meningitis due to Acinetobacter calcoaceticus in 10 children after ventriculoperitoneal shunt insertion Sir, Acinetobacter calcoaceticus is an uncommon cause of nosocomial meningitis.1 This organism may be multiply antibiotic resistant2 and outbreaks of infection have been reported, notably from intensive care units.3,4 We report 10 cases of nosocomial meningitis, caused by Acinetobacter calcoaceticus, in children, following ventriculoperitoneal shunt insertion. Six hundred and forty-five ventriculoperitoneal shunts were inserted over a seven-year period in three scovak paediatric centres and meningitis caused by A. calcoaceticus occurred in 10 children aged from 1 to 36 months. In five cases, infection occurred in neonates and in four in premature very low birth-weight neonates: eight of 10 children were cured without sequelae (follow up for 1 to 3 years) and two died, both of meningitis. Antibiotics were administered according to antimicrobial susceptibilities and the shunt was removed and reinserted in all cases. As part of the national nosocomial meningitis survey, univariate analysis identified ventriculoperitoneal shunt insertion (P < 0·001), prior neurosurgery (P < 0·03) and CNS abnormality (P < 0·001) as significant risk factors for Acinetobacter calcoaceticus nosocomial meningitis. Prognosis in terms of early sequelae was better for Acinetobacter calcoaceticus meningitis than for other forms of nosocomial meningitis, (P < 0·01) but the mortality rate is similar to that of nosocomial meningitis caused by other organisms.
Letters to the Editor
J. Filka, M. Huttova, D. Schwartzova, M. Kurak, T. Krc˘meryová, J. Tuharsky, K. Kralinsky, T. Sagat, V. Krc˘mery Jr.*
77
Dept. of Neonatology, Paediatric ICU and Paediatric Clinic, Postgraduate Medical School, 833 03 Bratislava and Kosice; *Dept. of Pharmacology, School of Public Health, Univ. of Trnava, Heydukova 10, 812 50 Bratislava, Slovak Republic
2. Beck-Sague CM, Jarvis WR, Brook JH et al. Epidemic bacteremia due to Acinetobacter baumanii in five intensive care units. Am J Epidemiol 1990; 132; 723–733. 3. Harstein AI, Rashad AL, Liebler JM et al. Multiple intensive care unit outbreak of Acinetobacter calcoaceticus subspecies anitratus respiratory infection and colonization associated with contamined reustable ventilator circuits and resuscitation bags. Am J Med 1988; 85: 624–631. 4. Vandenbroucke-Grauls CM, Kerver AJ, Rommers JH, Jansen R, den Dekker C, Verhoef J.: Endemic Acinetobacter anitratus in a surgical intensive care unit: mechanical ventilators as reservoir. Eur J Clin Microbiol Infect Dis 1988; 7: 485–489.
References 1. Nguyen HM, Harris SP, Muder RR, Pascualle AV. Antibiotic resistant Acinetobacter meningitis in neurosurgical patients. Neurosurgery 1994; 35; 851–855.
© 2000 The Hospital Infection Society
Letters to the Editor
Table 1 Pairwise t-test: Significant differences in accumulation of RP 62 A in relation to the tested biomaterial Material
Separate t-value
Degrees of freedom
Variance P-value
Steel versus: pmma PMMA polyethylene chrome cobalt titanium alloy ceramic Chrome cobalt versus PMMA PMMA versus ceramic
10·2 3·9 –2·1 1·16 0·61 12·99 –11·93
7 4 6 4 4 5 4
<0·0001 significant 0·015 0·0758 0·3046 0·5733 <0·0001 significant 0·0003 significant
D.P. König* J.M. Schierholz† C.H. Bertram*
*Department of Orthopaedic Surgery, Cologne University, Germany, †Department of Medical Microbiology and Hygiene, Cologne University, Germany
References 1. Blom AW, Bowker KE, Wooton M, MacGowan AP, Smith EJ, Bannister GC. Contamination of wounds by direct inoculation in total hip arthroplasty. J Hosp Inf 1998; 40:79–81. 2. Delmi M, Vaudaux PE, Descouts P, Lew PD, Vasey H. Role of fibronectin on staphylococcal adherence to metallic surfaces used as models of orthopaedic devices. In: Wadstöm T, Eliassin I, Holder I, Ljungh A. Wound and biomaterial-associated infections. Springer Verlag New York 1990; 349–351. 3. Oga M, Sugioka Y, Hobgood CD, Gristina AG, Myrvik QN. Surgical biomaterials and differential colonization by Staphylococcus epidermidis. Biomat 1988; 9:285–289. 4. Christensen GD, Simpson WA, Bisno AL, Beachey EH. Adherence of slime producing strains of Staphylococcus epidermidis to smooth surfaces. Infect Immun 1982; 37:318–326. 5. Schumacher-Perdreau F, Heilmann C, Peters G, Götz F, Pulverer G. Comparative analysis of a biofilmforming Staphylococcus epidermidis strain and its accumulation-negative isogenic mutant. FEMS Microbiol Lett 1994; 117:71–78. 6. König DP, Perdreau-Remington F, Rütt J, Stoβberger P, Hilgers RD, Plum G. Slime production of Staphylococcus epidermidis. Increased bacterial adherence and accumulation onto pure titanium. Acta Orthop Scand 1998; 69:523–526. 7. König DP, Rütt J, Hilgers RD, Perdreau-Remington F. Staphylococcus epidermidis colonisation of biomaterials used for orthopedic implants. Book of Abstracts. SIROT 1996 Amsterdam.
© 2000 The Hospital Infection Society
Article no. jhin.1999.0641, available online at http://www.idealibrary.com on
Nosocomial meningitis due to Acinetobacter calcoaceticus in 10 children after ventriculoperitoneal shunt insertion Sir, Acinetobacter calcoaceticus is an uncommon cause of nosocomial meningitis.1 This organism may be multiply antibiotic resistant2 and outbreaks of infection have been reported, notably from intensive care units.3,4 We report 10 cases of nosocomial meningitis, caused by Acinetobacter calcoaceticus, in children, following ventriculoperitoneal shunt insertion. Six hundred and forty-five ventriculoperitoneal shunts were inserted over a seven-year period in three scovak paediatric centres and meningitis caused by A. calcoaceticus occurred in 10 children aged from 1 to 36 months. In five cases, infection occurred in neonates and in four in premature very low birth-weight neonates: eight of 10 children were cured without sequelae (follow up for 1 to 3 years) and two died, both of meningitis. Antibiotics were administered according to antimicrobial susceptibilities and the shunt was removed and reinserted in all cases. As part of the national nosocomial meningitis survey, univariate analysis identified ventriculoperitoneal shunt insertion (P < 0·001), prior neurosurgery (P < 0·03) and CNS abnormality (P < 0·001) as significant risk factors for Acinetobacter calcoaceticus nosocomial meningitis. Prognosis in terms of early sequelae was better for Acinetobacter calcoaceticus meningitis than for other forms of nosocomial meningitis, (P < 0·01) but the mortality rate is similar to that of nosocomial meningitis caused by other organisms.
Letters to the Editor
J. Filka, M. Huttova, D. Schwartzova, M. Kurak, T. Krc˘meryová, J. Tuharsky, K. Kralinsky, T. Sagat, V. Krc˘mery Jr.*
77
Dept. of Neonatology, Paediatric ICU and Paediatric Clinic, Postgraduate Medical School, 833 03 Bratislava and Kosice; *Dept. of Pharmacology, School of Public Health, Univ. of Trnava, Heydukova 10, 812 50 Bratislava, Slovak Republic
2. Beck-Sague CM, Jarvis WR, Brook JH et al. Epidemic bacteremia due to Acinetobacter baumanii in five intensive care units. Am J Epidemiol 1990; 132; 723–733. 3. Harstein AI, Rashad AL, Liebler JM et al. Multiple intensive care unit outbreak of Acinetobacter calcoaceticus subspecies anitratus respiratory infection and colonization associated with contamined reustable ventilator circuits and resuscitation bags. Am J Med 1988; 85: 624–631. 4. Vandenbroucke-Grauls CM, Kerver AJ, Rommers JH, Jansen R, den Dekker C, Verhoef J.: Endemic Acinetobacter anitratus in a surgical intensive care unit: mechanical ventilators as reservoir. Eur J Clin Microbiol Infect Dis 1988; 7: 485–489.
References 1. Nguyen HM, Harris SP, Muder RR, Pascualle AV. Antibiotic resistant Acinetobacter meningitis in neurosurgical patients. Neurosurgery 1994; 35; 851–855.
© 2000 The Hospital Infection Society