Download PDF
CC BY-NC-ND 4.0 · Asian J Neurosurg 2019; 14(01): 102-105
DOI: 10.4103/ajns.AJNS_260_17
Original Article

Enterococcal meningitis/ventriculitis: A tertiary care experience

Iffat Khanum
Department of Medicine, Liaquat National Hospital and Medical College, Karachi
,
Sana Anwar
1   Department of Microbiology, Liaquat National Hospital and Medical College, Karachi
,
Aisha Farooque
Department of Medicine, Liaquat National Hospital and Medical College, Karachi
› Author Affiliations
› Further Information
   Permissions and Reprints

Context: Enterococcal meningitis is very rare among bacterial meningitis and has variable clinical outcomes. Aims: The purpose of the current study is to evaluate clinical features, therapeutic options with susceptibility profile, and outcomes of enterococcal meningitis in a tertiary care hospital. Settings and Design: We retrospectively reviewed medical records of all patients with enterococcal meningitis over the periods of 4 years. Subjects and Methods: The clinical and laboratory data of all patients with enterococcal meningitis were evaluated between 2013 and 2016. Results: Six cases of enterococcal meningitis were found (three infant and three adults). All patients developed meningitis after neurosurgical procedures, and majority of patients (four out of six) had central nervous system (CNS) devices in situ at the time of development of meningitis. The causative organism isolated from cerebrospinal fluid (CSF) culture of all patients was Enterococcus species only. All Enterococcus spp. were resistant to ampicillin, Amoxicillin-clavulanate, and oxytetracycline and two isolates were also resistant to vancomycin. Four patients with vancomycin-sensitive Enterococcus spp. were treated with vancomycin alone for mean periods of 18 days (14–21 days). One patient with vancomycin-resistant Enterococcus (VRE) meningitis was treated with linezolid alone, and another one requires combination with rifampicin to achieve microbiological clearance of CSF. CNS devices were removed in all patients. No mortality was reported in current case series. Conclusions: Enterococcal meningitis is very uncommon, mostly associated with neurosurgical intervention. Early treatment is associated with favorable outcomes. Removal of CNS devices is recommended to achieve a clinical cure.

Key-words:

Enterococcus species - nosocomial meningitis - vancomycin-resistant Enterococcus

Financial support and sponsorship

Nil.




Publication History

Article published online:
09 September 2022

© 2019. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Giridhara Upadhyaya PM, Ravikumar KL, Umapathy BL. Review of virulence factors of Enterococcus: An emerging nosocomial pathogen. Indian J Med Microbiol 2009;27:301-5.
  • 2 Olawale KO, Fadiora SO, Taiwo SS. Prevalence of hospital-acquired enterococci infections in two primary-care hospitals in Osogbo, Southwestern Nigeria. Afr J Infect Dis 2011;5:40-6.
  • 3 Hollenbeck BL, Rice LB. Intrinsic and acquired resistance mechanisms in Enterococcus. Virulence 2012;3:421-33.
  • 4 Laguna Del Estal P, García Zubiri C, García Madero R, Gil Navarro M. Enterococcal meningitis in adults. Neurologia 2009;24:245-8.
  • 5 Pintado V, Cabellos C, Moreno S, Meseguer MA, Ayats J, Viladrich PF, et al. Enterococcal meningitis: A clinical study of 39 cases and review of the literature. Medicine (Baltimore) 2003;82:346-64.
  • 6 Lu Y, Huang C, Lu C, Chang W, Chen N, Chuang Y. Clinical characteristics and therapeutic outcomes of adult enterococcal meningitis. J Int Med Taiwan 2014;25:424-31.
  • 7 Dhanalakshmi TA, Vijaya S, Sharieff S. Spontaneous enterococcal meningitis: A case report. J Med Sci Health 2015;1:1-2.
  • 8 McClelland S 3rd, Hall WA. Postoperative central nervous system infection: Incidence and associated factors in 2111 neurosurgical procedures. Clin Infect Dis 2007;45:55-9.
  • 9 Chen C, Zhang B, Yu S, Sun F, Ruan Q, Zhang W, et al. The incidence and risk factors of meningitis after major craniotomy in China: A retrospective cohort study. PLoS One 2014;9:e101961.
  • 10 van de Beek D, Drake JM, Tunkel AR. Nosocomial bacterial meningitis. N Engl J Med 2010;362:146-54.
  • 11 Erdem I, Hakan T, Ceran N, Metin F, Akcay SS, Kucukercan M, et al. Clinical features, laboratory data, management and the risk factors that affect the mortality in patients with postoperative meningitis. Neurol India 2008;56:433-7.
  • 12 Hebbar S, Upadyaya S. A case of enterococcal meningitis in a healthy infant. Int J Infect Dis 2004;4:1-3.
  • 13 Stevenson KB, Murray EW, Sarubbi FA. Enterococcal meningitis: Report of four cases and review. Clin Infect Dis 1994;18:233-9.
  • 14 Baddour LM, Wilson WR, Bayer AS, Fowler VG Jr., Tleyjeh IM, Rybak MJ, et al. Infective endocarditis in adults: Diagnosis, antimicrobial therapy, and management of complications: A Scientific statement for healthcare professionals from the American Heart Association. Circulation 2015;132:1435-86.
  • 15 Wang JS, Muzevich K, Edmond MB, Bearman G, Stevens MP. Central nervous system infections due to vancomycin-resistant enterococci: Case series and review of the literature. Int J Infect Dis 2014;25:26-31.
  • 16 Knoll BM, Hellmann M, Kotton CN. Vancomycin-resistant Enterococcus faecium meningitis in adults: Case series and review of the literature. Scand J Infect Dis 2013;45:131-9.
  • 17 Heintz BH, Cho S, Fujioka A, Li J, Halilovic J. Evaluation of the treatment of vancomycin-resistant enterococcal urinary tract infections in a large academic medical center. Ann Pharmacother 2013;47:159-69.
  • 18 Patel R, Gallagher JC. Vancomycin-resistant enterococcal bacteremia pharmacotherapy. Ann Pharmacother 2015;49:69-85.
  • 19 Erlandson KM, Sun J, Iwen PC, Rupp ME. Impact of the more-potent antibiotics quinupristin-dalfopristin and linezolid on outcome measure of patients with vancomycin-resistant Enterococcus bacteremia. Clin Infect Dis 2008;46:30-6.
  • 20 Luque S, Grau S, Alvarez-Lerma F, Ferrández O, Campillo N, Horcajada JP, et al. Plasma and cerebrospinal fluid concentrations of linezolid in neurosurgical critically ill patients with proven or suspected central nervous system infections. Int J Antimicrob Agents 2014;44:409-15.
  • 21 Steinmetz MP, Vogelbaum MA, De Georgia MA, Andrefsky JC, Isada C. Successful treatment of vancomycin-resistant Enterococcus meningitis with linezolid: Case report and review of the literature. Crit Care Med 2001;29:2383-5.
  • 22 Qiu JJ, Tang J, Li DL. Success of linezolid therapy for post neurosurgical ventriculitis due to vancomycin-resistant Enterococcus faecium: Case report and literature review. Chin Neurosurg J 2015;1:18.
  • 23 da Silva PS, Monteiro Neto H, Sejas LM. Successful treatment of vancomycin-resistant Enterococcus ventriculitis in a child. Braz J Infect Dis 2007;11:297-9.
  • 24 Lich BF, Conner AK, Burks JD, Glenn CA, Sughrue ME. Intrathecal/Intraventricular linezolid in multidrug-resistant Enterococcus faecalis ventriculitis. J Neurol Surg Rep 2016;77:e160-1.
  • 25 Mueller SW, Kiser TH, Anderson TA, Neumann RT. Intraventricular daptomycin and intravenous linezolid for the treatment of external ventricular-drain-associated ventriculitis due to vancomycin-resistant Enterococcus faecium. Ann Pharmacother 2012;46:e35.
  • 26 Tan TY, Pitman I, Penrose-Stevens A, Simpson BA, Flanagan PG. Treatment of a vancomycin-resistant Enterococcus faecium ventricular drain infection with quinupristin/dalfopristin and review of the literature. J Infect 2000;41:95-7.
  • 27 Hartmann C, Peter C, Hermann E, Ure B, Sedlacek L, Hansen G, et al. Successful treatment of vancomycin-resistant Enterococcus faecium ventriculitis with combined intravenous and intraventricular chloramphenicol in a newborn. J Med Microbiol 2010;59:1371-4.
  • 28 Tunkel AR, Hasbun R, Bhimraj A, Byers K, Kaplan SL, Michael Scheld W, et al. 2017 infectious diseases society of America's clinical practice guidelines for healthcare-associated ventriculitis and meningitis. Clin Infect Dis 2017;64:e34-e65.