- Email: [email protected]
P1208 Community-acquired Listeria monocytogenes meningitis in adults
S330
17th ECCMID / 25th ICC, Posters
patients had pneumonia. All patients were comatose at admission. Twelve patients reported fever before admission. Meningeal signs were present in 11 cases. Exam of the cerebrospinal fluid showed always pleocytosis, low CSF/serum glucose ratio and elevated protein. White blood cell count was 11,100/mL (range 3,900–30,000). Three of 5 patients presenting with CSF cell count below 500/mL died. Penicillinsusceptible strains of S. pneumoniae grew in 10 cases; in the remaining 4 cases penicillin-nonsusceptible strains were cultured. Patients received combined treatment with ceftriaxone associated to ampicillin (5 cases), vancomycin (5 cases), rifampin (2 cases) or linezolid (2 cases) as empirical treatment. Four patients died, 2 had neurological sequelae. Three deaths occurred in patients with Child–Pugh C cirrhosis. Child– Pugh score improved in surviving cases. Conclusions: Pneumococcal meningitis should be suspected in cirrhotic patients with fever and changes in mental status, particularly when predisposing factors are present. Outcome and mortality are related to the severity of liver disease. The increasing incidence of penicillinnonsusceptible strains must be considered in establishing the empirical treatment. P1206 Repeated lumbar puncture in patients with pneumococcal meningitis: practical or anxiolytic relevance? A. Alvarez, B. Mourvillier, H. Bout, C. Bruel, L. Ferreira, K. Lakhal, O. Pajot, L. Bouadma, B. Regnier, M. Wolff (Paris, FR) Introduction: Repeated lumbar puncture (RLP) is recommanded in patients with pneumococcal meningitis who have not responded clinically after 48 h of appropiate antimicrobial therapy or in pneumococcal meningitis caused by penicillin- or cephalosporin-resistant strains (PNSP). Nevertheless the clinical impact of this practice is uncertain. Patients and Methods: Retrospective analysis of charts of patients admitted in our 25-bed university medical ICU between January 2000 and December 2005, for pneumococcal meninigitis. All patients were appropiately treated according to international guidelines. The following data were collected at admission: clinical features, CSF characteristics: leukocyte count, protein and glucose concentrations, Gram stain and MIC of penicillin G. RLP data and changes in antibiotics dosage after results, were also noted. Results: Among 51 included patients, 32 (63%) underwent RLP (RLP+) and were compared to 19 (37%) without RLP (RLP−). The mean delay between the first lumbar puncture and RLP was 4±2.5 days. RLP+ patients were older (59±14 vs 48±17 years), more severe at admission (SAPS II: 43±13 vs 29±4); had a more severely altered mental status (GCS 8±3 vs 12±3); and ICU length of stay was longer (23±15 d vs 4±3 d). The number of PNSP strains was 7 and 2 respectively (p = 0.52). Characteristics of the first lumbar puncture were not different in the two groups, except for leucocyte count (1,766±2,190 vs 4,064±4,080, p < 0.05). There was no difference in mortality (9% in RLP+ group vs 5% in RLP− group, p = 1) but a tendency toward a larger number of sequelae in the RLP+ group (34.4% vs 9.5%, p = 0.08). Gram stain was positive in 47% of RLP but cultures were always sterile. The comparison between admission and RLP is shown in the table. Cefotaxime concentrations in CSF were measured in 14 patients and showed a level >5MIC in 4 and 10MIC in 9 patients, respectively. In one case cefotaxime concentration was <5MIC but the outcome was favourable. In none of the patients, the results of the RLP led to modifications of the antibiotic treatment.
Temperature (ºC) Leukocytes/mm3 Protein (g/L) Glucose level (mmol/L)
Day 1
Repeated lumbar puncture
p
39.2±1.2 1,773±2,155 6.7±4.3 1.1±2
37.7±1.1 3,713±6,334 3.3±2.6 2.7±2.5
<0.05 0.11 <0.05 <0.05
Conclusion: When internationals treatment guidelines for pneumococcal meningitis are applied, based on pneumococcal resistance epidemiology, bacteriological failure seems improbable. Therefore, RLP may be unnecessary in this context. This hypothesis needs to be confirmed by a larger prospective study. P1207 Treatment outcomes in adult purulent meningitis: a specialised centre experience in the Czech Republic O. Dzupova, M. Helcl, J. Prihodova, J. Benes, H. Rohacova (Prague, CZ) Objectives: Despite the availability of highly effective antimicrobials and intensive care in the last decades purulent meningitis continues to be a life-threatening disease burdened with an average mortality rate of 20−40%. The aim of the study is to report on outcomes of patients with purulent meningitis treated in a specialised centre. Methods: A prospective study performed in years 1997–2004 which included all consecutive patients older than 16 years with diagnosis of purulent meningitis, both community-acquired and hospital-acquired, treated at the Infectious Diseases Department in Bulovka University Hospital, Prague. Patients with purulent meningitis are concentrated at the intensive care unit (ICU) of the Department from the subregion of c. 2-million population and account for ~20% of all patients admitted at ICU. The outcomes were classified using the Glasgow Outcome Scale (GOS) score: 1, death; 2, vegetative state; 3, severe disability; 4, moderate disability; 5, mild or no disability. Results: The study group consisted of 241 patients (134 men, 107 women), mean age 47.2 years (range 16−85 years). During the primary hospitalisation 44 patients died (18.3%). One hundred forty five patients (60.1%) were discharged to their homes; 52 patients (21.6%) were transferred to other healthcare facilities for rehabilitation or long-term hospital care. Six months after the onset of disease the outcomes were reassessed. Twelve patients were lost for the follow-up for various reasons. One hundred and forty five patients (58.1%) were assessed with GOS 5; 27 patients (11.2%) with GOS 4; 10 patients (4.2%) with GOS 3; 2 patients (0.8%) with GOS 2; and 50 patients (20.7%) with GOS 1. Thus, in 62 patients (25.7%) the disease had got unfavourable outcome (GOS 1−3). Conclusion: Relatively low rate of patients with unfavourable outcome in our study in comparison with data reported in the literature lead us to recommendation to centralise and treat patients with purulent meningitis in specialised centres with fully equipped intensive care unit and experienced personnel. P1208 Community-acquired Listeria monocytogenes meningitis in adults R. Amaya-Villar, E. Garcia Cabrera, E. Sulleiro, M.E. Jim´enez-Mej´ıas, D. Roriguez, P. Fern´andez-Viladrich, A. Coloma, P. Catalan, C. Rodrigo, D. Fontanals, F. Grill, M.L. Juli´a, J.A. V´azquez, J. Pach´on, G. Prats (Seville, Barcelona, Madrid, Valencia, ES) Methods: A descriptive, prospective, and multicentre study carried out in 9 hospitals of the Spanish Network for the Research in Infectious Diseases (REIPI) between 1/11/2003 and 31/07/2006. Patients: Three hundred and twenty-four adult patients with acute community-acquired bacterial meningitis were included. Forty-five episodes of Listeria monocytogenes meningitis were identified in 45 adult patients. All these cases were diagnosed on the basis of a compatible clinical and biological picture and a positive cerebrospinal fluid (CSF) or blood cultures. Results: All 45 patients were either immunocompromised or aged over 60 years. The classic triad of fever, neck stiffness and altered mental status was present in 21 (46.7%) patients, however, almost all patients (95%) had at least 1 or more of these symptoms. CSF samples obtained through lumbar puncture showed a median WBC count of 550 per mm3 (interquartile range 0–70.000 per mm3 ); a glucose level of 39 (0.4– 158) mg/dL; a ratio of CSF glucose to blood glucose of 0.27 (0.0–0.65); and a protein level of 181 (20–674) mg/dL. Gram stain of CSF samples was performed for 97.8% patients and it was positive in 12 (27.7%) of
Meningitis 44 cases. CSF and blood cultures were positive in 88.8% and 67.4%, respectively. The serotype more frequently found was the 4b in 16 (72.2%) of 22 cases. In 18 (40%) of 45 cases, the patients received empirical antimicrobial therapy. The initial antimicrobial therapy was ampicillin based for 35 (77.7%) of 45 patients, in 12 (34.3%) of them associated to aminoglycosides. Twenty-one patients (46.6%) received adjunctive therapy with dexamethasone; in 16 cases, the first dose was given previously or concomitantly to the first antibiotic dose. The median length of hospital stay was 20 (7−34) days. The mortality rate was 28.9% (13 of 45 patients) and 4 (8.9%) developed adverse clinical outcome (neurological and/or auditory sequels). Inadequate initial antimicrobial therapy was not related to outcome. Conclusions: Listeria monocytogenes meningitis predominantly occurs in elderly or immunocompromised patients. Patients with Listeria monocytogenes meningitis often present with classic symptoms of bacterial meningitis. This clinical process also remains a serious disease that carries high morbidity and mortality rates.
P1209 A risk score for unfavourable outcome in adults with bacterial meningitis M. Weisfelt, D. van de Beek, L. Spanjaard, J.B. Reitsma, J. de Gans (Amsterdam, NL) Objectives: Clinical deterioration in bacterial meningitis can occur rapidly and is often difficult to predict. Identification of highrisk patients would be helpful in decision-making regarding the management of individual patients. The aim of the present study was to derive and validate a simple risk score to predict the risk for an unfavourable outcome in individual adults with community-acquired bacterial meningitis. Methods: We derived a score for the risk of an unfavourable outcome by performing a multivariate logistic regression analysis of data from a prospective nationwide cohort study (Dutch Meningitis Cohort, DMC; n = 696). A key set of independent prognostic variables was selected from a starting set of 22 potential predictors by backward elimination procedure using bootstrap techniques to avoid the inclusion of spurious variables. A nomogram based on these key variables was constructed to facilitate the use in clinical practice. For validation, we used data from a randomised controlled trial of adjunctive dexamethasone therapy for adults with bacterial meningitis (European Dexamethasone Study, EDS; n = 301).
S331 Results: Of the 696 episodes in the DMC, 237 (34%) had an unfavourable outcome, including 143 patients (21%) who died. The risk score was based on 6 routinely available variables: age, heart rate, score on the Glasgow Coma Scale, cranial nerve palsies, cerebrospinal fluid leukocyte count, and Gram-positive cocci in cerebrospinal fluid Gram’s stain (figure 1). The concordance index for the final risk score in the EDS was 0.73 (95% confidence interval 0.65–0.80). Conclusion: This bedside risk score can be used to reliably predict the individual risk for unfavourable outcome in adults with communityacquired bacterial meningitis. P1210 Antibiotic resistance among Gram-negative bacilli causing meningitis in an adult neurosurgical centre in Manchester, UK: implications for effective antibiotic therapy N. Doshi, T. Wilson, C. Subudhi (Salford, UK) Objectives: Gram negative bacillary meningitis (GNBM) is an uncommon infection in adults and often occurs as a complication of complex neurosurgical procedure or following head injury. The treatment of Gram-negative bacillary meningitis remains a major therapeutic challenge with emergence of antibiotic resistance in many of the causative organisms and the restricted choice of antibiotics. We reviewed the aetiology and antimicrobial susceptibility pattern of GNBM in our centre over a 7 year period. Methods: Hope Hospital, Salford is a 900 bed tertiary referral hospital, which houses the regional neurosurgical centre for Greater Manchester. The case notes and microbiological records of all patients with GNBM between 2000 and 2006 inclusive were reviewed retrospectively. Only patients with positive CSF culture and clinical features compatible with meningitis were included. Results: During the study period, there were 74 patients who had GNBM from whom 92 different Gram-negative bacilli were isolated in CSF. The most common causative organisms were Enterobacter spp. (27.2%), E. coli (21.7%) and Klebsiella spp. (16.3%). More than one third (38%) of Gram-negative bacillary isolates were resistant to third generation cephalosporins. 17% of isolates were resistant to gentamicin and 10% were resistant to ciprofloxacin. All the isolates were sensitive to meropenem and amikacin. Conclusions: Third generation cephalosporins have been the mainstay to treat GNBM over the past 20 years because of high CSF penetrance. This has resulted in dramatic fall in meningitis related mortality. Emergence of strains resistant to third generation cephalosporins is a significant cause of concern. This retrospective study has highlighted that surveillance of local pathogens and resistance patterns are essential to guide empirical therapy. This study has prompted us to consider initiating empiric therapy for post neurosurgical GNBM with meropenem pending culture and susceptibility results. P1211 Nosocomial meningitis E. Garcia-Cabrera, M.E. Jim´enez-Mej´ıas, J. Serra-Vich, V. Pintado, F. Grill, M. Portillo, J. Colomina, G. Prats, J. Pach´on-Diaz (Seville, Barcelona, Madrid, Valencia, ES)
Fig. 1.
Objectives: Study of epidemiology, demography and risk factors, clinical and cerebrospinal fluid (CSF) variables, aetiology and prognosis of a cohort of patients with nosocomial meningitis/ventriculitis (NM). Methods: Multicentre and prospective study in six tertiary REIPI hospitals, from September 2004 to July 2006. Inclusion criteria: adults undergoing neurosurgical or spinal or facial skull surgical, or head trauma, with NM. Diagnosis NM: clinical features, CSF findings (pleocytosis, hypoglycorrachia or CSF/blood glucose ratio <40%, and increased protein level) and microbiological criteria (microbial presence in Gram smears and/or isolation from CSF). Monitoring: 30 days after treatment withdrawal. Results: A total of 106 patients (57% males) were studied. Median age: 49.5±26.9 years (15−75). Risk factor: temporal shunt 83 patients (79%), neurosurgery 75 (71%), CSF fistula 26 (25%), permanent drainage
17th ECCMID / 25th ICC, Posters
patients had pneumonia. All patients were comatose at admission. Twelve patients reported fever before admission. Meningeal signs were present in 11 cases. Exam of the cerebrospinal fluid showed always pleocytosis, low CSF/serum glucose ratio and elevated protein. White blood cell count was 11,100/mL (range 3,900–30,000). Three of 5 patients presenting with CSF cell count below 500/mL died. Penicillinsusceptible strains of S. pneumoniae grew in 10 cases; in the remaining 4 cases penicillin-nonsusceptible strains were cultured. Patients received combined treatment with ceftriaxone associated to ampicillin (5 cases), vancomycin (5 cases), rifampin (2 cases) or linezolid (2 cases) as empirical treatment. Four patients died, 2 had neurological sequelae. Three deaths occurred in patients with Child–Pugh C cirrhosis. Child– Pugh score improved in surviving cases. Conclusions: Pneumococcal meningitis should be suspected in cirrhotic patients with fever and changes in mental status, particularly when predisposing factors are present. Outcome and mortality are related to the severity of liver disease. The increasing incidence of penicillinnonsusceptible strains must be considered in establishing the empirical treatment. P1206 Repeated lumbar puncture in patients with pneumococcal meningitis: practical or anxiolytic relevance? A. Alvarez, B. Mourvillier, H. Bout, C. Bruel, L. Ferreira, K. Lakhal, O. Pajot, L. Bouadma, B. Regnier, M. Wolff (Paris, FR) Introduction: Repeated lumbar puncture (RLP) is recommanded in patients with pneumococcal meningitis who have not responded clinically after 48 h of appropiate antimicrobial therapy or in pneumococcal meningitis caused by penicillin- or cephalosporin-resistant strains (PNSP). Nevertheless the clinical impact of this practice is uncertain. Patients and Methods: Retrospective analysis of charts of patients admitted in our 25-bed university medical ICU between January 2000 and December 2005, for pneumococcal meninigitis. All patients were appropiately treated according to international guidelines. The following data were collected at admission: clinical features, CSF characteristics: leukocyte count, protein and glucose concentrations, Gram stain and MIC of penicillin G. RLP data and changes in antibiotics dosage after results, were also noted. Results: Among 51 included patients, 32 (63%) underwent RLP (RLP+) and were compared to 19 (37%) without RLP (RLP−). The mean delay between the first lumbar puncture and RLP was 4±2.5 days. RLP+ patients were older (59±14 vs 48±17 years), more severe at admission (SAPS II: 43±13 vs 29±4); had a more severely altered mental status (GCS 8±3 vs 12±3); and ICU length of stay was longer (23±15 d vs 4±3 d). The number of PNSP strains was 7 and 2 respectively (p = 0.52). Characteristics of the first lumbar puncture were not different in the two groups, except for leucocyte count (1,766±2,190 vs 4,064±4,080, p < 0.05). There was no difference in mortality (9% in RLP+ group vs 5% in RLP− group, p = 1) but a tendency toward a larger number of sequelae in the RLP+ group (34.4% vs 9.5%, p = 0.08). Gram stain was positive in 47% of RLP but cultures were always sterile. The comparison between admission and RLP is shown in the table. Cefotaxime concentrations in CSF were measured in 14 patients and showed a level >5MIC in 4 and 10MIC in 9 patients, respectively. In one case cefotaxime concentration was <5MIC but the outcome was favourable. In none of the patients, the results of the RLP led to modifications of the antibiotic treatment.
Temperature (ºC) Leukocytes/mm3 Protein (g/L) Glucose level (mmol/L)
Day 1
Repeated lumbar puncture
p
39.2±1.2 1,773±2,155 6.7±4.3 1.1±2
37.7±1.1 3,713±6,334 3.3±2.6 2.7±2.5
<0.05 0.11 <0.05 <0.05
Conclusion: When internationals treatment guidelines for pneumococcal meningitis are applied, based on pneumococcal resistance epidemiology, bacteriological failure seems improbable. Therefore, RLP may be unnecessary in this context. This hypothesis needs to be confirmed by a larger prospective study. P1207 Treatment outcomes in adult purulent meningitis: a specialised centre experience in the Czech Republic O. Dzupova, M. Helcl, J. Prihodova, J. Benes, H. Rohacova (Prague, CZ) Objectives: Despite the availability of highly effective antimicrobials and intensive care in the last decades purulent meningitis continues to be a life-threatening disease burdened with an average mortality rate of 20−40%. The aim of the study is to report on outcomes of patients with purulent meningitis treated in a specialised centre. Methods: A prospective study performed in years 1997–2004 which included all consecutive patients older than 16 years with diagnosis of purulent meningitis, both community-acquired and hospital-acquired, treated at the Infectious Diseases Department in Bulovka University Hospital, Prague. Patients with purulent meningitis are concentrated at the intensive care unit (ICU) of the Department from the subregion of c. 2-million population and account for ~20% of all patients admitted at ICU. The outcomes were classified using the Glasgow Outcome Scale (GOS) score: 1, death; 2, vegetative state; 3, severe disability; 4, moderate disability; 5, mild or no disability. Results: The study group consisted of 241 patients (134 men, 107 women), mean age 47.2 years (range 16−85 years). During the primary hospitalisation 44 patients died (18.3%). One hundred forty five patients (60.1%) were discharged to their homes; 52 patients (21.6%) were transferred to other healthcare facilities for rehabilitation or long-term hospital care. Six months after the onset of disease the outcomes were reassessed. Twelve patients were lost for the follow-up for various reasons. One hundred and forty five patients (58.1%) were assessed with GOS 5; 27 patients (11.2%) with GOS 4; 10 patients (4.2%) with GOS 3; 2 patients (0.8%) with GOS 2; and 50 patients (20.7%) with GOS 1. Thus, in 62 patients (25.7%) the disease had got unfavourable outcome (GOS 1−3). Conclusion: Relatively low rate of patients with unfavourable outcome in our study in comparison with data reported in the literature lead us to recommendation to centralise and treat patients with purulent meningitis in specialised centres with fully equipped intensive care unit and experienced personnel. P1208 Community-acquired Listeria monocytogenes meningitis in adults R. Amaya-Villar, E. Garcia Cabrera, E. Sulleiro, M.E. Jim´enez-Mej´ıas, D. Roriguez, P. Fern´andez-Viladrich, A. Coloma, P. Catalan, C. Rodrigo, D. Fontanals, F. Grill, M.L. Juli´a, J.A. V´azquez, J. Pach´on, G. Prats (Seville, Barcelona, Madrid, Valencia, ES) Methods: A descriptive, prospective, and multicentre study carried out in 9 hospitals of the Spanish Network for the Research in Infectious Diseases (REIPI) between 1/11/2003 and 31/07/2006. Patients: Three hundred and twenty-four adult patients with acute community-acquired bacterial meningitis were included. Forty-five episodes of Listeria monocytogenes meningitis were identified in 45 adult patients. All these cases were diagnosed on the basis of a compatible clinical and biological picture and a positive cerebrospinal fluid (CSF) or blood cultures. Results: All 45 patients were either immunocompromised or aged over 60 years. The classic triad of fever, neck stiffness and altered mental status was present in 21 (46.7%) patients, however, almost all patients (95%) had at least 1 or more of these symptoms. CSF samples obtained through lumbar puncture showed a median WBC count of 550 per mm3 (interquartile range 0–70.000 per mm3 ); a glucose level of 39 (0.4– 158) mg/dL; a ratio of CSF glucose to blood glucose of 0.27 (0.0–0.65); and a protein level of 181 (20–674) mg/dL. Gram stain of CSF samples was performed for 97.8% patients and it was positive in 12 (27.7%) of
Meningitis 44 cases. CSF and blood cultures were positive in 88.8% and 67.4%, respectively. The serotype more frequently found was the 4b in 16 (72.2%) of 22 cases. In 18 (40%) of 45 cases, the patients received empirical antimicrobial therapy. The initial antimicrobial therapy was ampicillin based for 35 (77.7%) of 45 patients, in 12 (34.3%) of them associated to aminoglycosides. Twenty-one patients (46.6%) received adjunctive therapy with dexamethasone; in 16 cases, the first dose was given previously or concomitantly to the first antibiotic dose. The median length of hospital stay was 20 (7−34) days. The mortality rate was 28.9% (13 of 45 patients) and 4 (8.9%) developed adverse clinical outcome (neurological and/or auditory sequels). Inadequate initial antimicrobial therapy was not related to outcome. Conclusions: Listeria monocytogenes meningitis predominantly occurs in elderly or immunocompromised patients. Patients with Listeria monocytogenes meningitis often present with classic symptoms of bacterial meningitis. This clinical process also remains a serious disease that carries high morbidity and mortality rates.
P1209 A risk score for unfavourable outcome in adults with bacterial meningitis M. Weisfelt, D. van de Beek, L. Spanjaard, J.B. Reitsma, J. de Gans (Amsterdam, NL) Objectives: Clinical deterioration in bacterial meningitis can occur rapidly and is often difficult to predict. Identification of highrisk patients would be helpful in decision-making regarding the management of individual patients. The aim of the present study was to derive and validate a simple risk score to predict the risk for an unfavourable outcome in individual adults with community-acquired bacterial meningitis. Methods: We derived a score for the risk of an unfavourable outcome by performing a multivariate logistic regression analysis of data from a prospective nationwide cohort study (Dutch Meningitis Cohort, DMC; n = 696). A key set of independent prognostic variables was selected from a starting set of 22 potential predictors by backward elimination procedure using bootstrap techniques to avoid the inclusion of spurious variables. A nomogram based on these key variables was constructed to facilitate the use in clinical practice. For validation, we used data from a randomised controlled trial of adjunctive dexamethasone therapy for adults with bacterial meningitis (European Dexamethasone Study, EDS; n = 301).
S331 Results: Of the 696 episodes in the DMC, 237 (34%) had an unfavourable outcome, including 143 patients (21%) who died. The risk score was based on 6 routinely available variables: age, heart rate, score on the Glasgow Coma Scale, cranial nerve palsies, cerebrospinal fluid leukocyte count, and Gram-positive cocci in cerebrospinal fluid Gram’s stain (figure 1). The concordance index for the final risk score in the EDS was 0.73 (95% confidence interval 0.65–0.80). Conclusion: This bedside risk score can be used to reliably predict the individual risk for unfavourable outcome in adults with communityacquired bacterial meningitis. P1210 Antibiotic resistance among Gram-negative bacilli causing meningitis in an adult neurosurgical centre in Manchester, UK: implications for effective antibiotic therapy N. Doshi, T. Wilson, C. Subudhi (Salford, UK) Objectives: Gram negative bacillary meningitis (GNBM) is an uncommon infection in adults and often occurs as a complication of complex neurosurgical procedure or following head injury. The treatment of Gram-negative bacillary meningitis remains a major therapeutic challenge with emergence of antibiotic resistance in many of the causative organisms and the restricted choice of antibiotics. We reviewed the aetiology and antimicrobial susceptibility pattern of GNBM in our centre over a 7 year period. Methods: Hope Hospital, Salford is a 900 bed tertiary referral hospital, which houses the regional neurosurgical centre for Greater Manchester. The case notes and microbiological records of all patients with GNBM between 2000 and 2006 inclusive were reviewed retrospectively. Only patients with positive CSF culture and clinical features compatible with meningitis were included. Results: During the study period, there were 74 patients who had GNBM from whom 92 different Gram-negative bacilli were isolated in CSF. The most common causative organisms were Enterobacter spp. (27.2%), E. coli (21.7%) and Klebsiella spp. (16.3%). More than one third (38%) of Gram-negative bacillary isolates were resistant to third generation cephalosporins. 17% of isolates were resistant to gentamicin and 10% were resistant to ciprofloxacin. All the isolates were sensitive to meropenem and amikacin. Conclusions: Third generation cephalosporins have been the mainstay to treat GNBM over the past 20 years because of high CSF penetrance. This has resulted in dramatic fall in meningitis related mortality. Emergence of strains resistant to third generation cephalosporins is a significant cause of concern. This retrospective study has highlighted that surveillance of local pathogens and resistance patterns are essential to guide empirical therapy. This study has prompted us to consider initiating empiric therapy for post neurosurgical GNBM with meropenem pending culture and susceptibility results. P1211 Nosocomial meningitis E. Garcia-Cabrera, M.E. Jim´enez-Mej´ıas, J. Serra-Vich, V. Pintado, F. Grill, M. Portillo, J. Colomina, G. Prats, J. Pach´on-Diaz (Seville, Barcelona, Madrid, Valencia, ES)
Fig. 1.
Objectives: Study of epidemiology, demography and risk factors, clinical and cerebrospinal fluid (CSF) variables, aetiology and prognosis of a cohort of patients with nosocomial meningitis/ventriculitis (NM). Methods: Multicentre and prospective study in six tertiary REIPI hospitals, from September 2004 to July 2006. Inclusion criteria: adults undergoing neurosurgical or spinal or facial skull surgical, or head trauma, with NM. Diagnosis NM: clinical features, CSF findings (pleocytosis, hypoglycorrachia or CSF/blood glucose ratio <40%, and increased protein level) and microbiological criteria (microbial presence in Gram smears and/or isolation from CSF). Monitoring: 30 days after treatment withdrawal. Results: A total of 106 patients (57% males) were studied. Median age: 49.5±26.9 years (15−75). Risk factor: temporal shunt 83 patients (79%), neurosurgery 75 (71%), CSF fistula 26 (25%), permanent drainage