Foster David R, Rhoney Denise H
Department of Pharmacy Practice, School of Pharmacy and Pharmacal Sciences, Purdue University, West Lafayette, IN 47907, USA.
Surg Neurol. 2005 Jun;63(6):533-7; discussion 537. doi: 10.1016/j.surneu.2004.06.018.
Meningitis due to Enterobacter species is an uncommon infection in adults; however, when present, treatment is frequently complicated by resistance of many Enterobacter isolates to third-generation cephalosporins and poor central nervous system penetration of other antibiotics. The aim of this study was to retrospectively review cases of meningitis caused by Enterobacter species at our institution, to better characterize patient factors, pathogen characteristics, and treatment options for this infection.
We reviewed all cases of Enterobacter meningitis in a 12-year period at a tertiary care center. Data collected included patient demographics, antibiotic sensitivities of Enterobacter isolates, antimicrobial therapy, and patient outcomes.
Nineteen cases were identified, primarily in patients with neurotrauma and in neurosurgical patients. Enterobacter cloacae was the most frequent Enterobacter species isolated followed by Enterobacter aerogenes and Enterobacter agglomerans (50%, 34%, and 16% of cultures, respectively). Overall, clinical cure/improvement was achieved in 47% of patients, and the mortality rate was 21%. Antibiotic treatment varied substantially and included third-generation cephalosporins, intravenous and intrathecal aminoglycosides, trimethoprim-sulfamethoxazole (TMP-SMX), piperacillin, ciprofloxacin, and other miscellaneous antibiotics. Treatment with TMP-SMX was associated with a high rate of clinical cure/improvement, whereas third-generation cephalosporins were less efficacious.
Enterobacter meningitis is an infrequent complication of neurological insult. Treatment is often complicated by resistance of Enterobacter species to third-generation cephalosporins. Our results indicate that while third-generation cephalosporins are not the most appropriate choice of agents to treat Enterobacter meningitis, TMP-SMX may yield satisfactory results.
肠杆菌属所致脑膜炎在成人中是一种不常见的感染；然而，一旦发生，治疗常常因许多肠杆菌分离株对第三代头孢菌素耐药以及其他抗生素在中枢神经系统的渗透性差而变得复杂。本研究的目的是回顾性分析我院由肠杆菌属引起的脑膜炎病例，以更好地描述该感染的患者因素、病原体特征及治疗选择。
我们回顾了一家三级医疗中心12年间所有肠杆菌性脑膜炎病例。收集的数据包括患者人口统计学资料、肠杆菌分离株的抗生素敏感性、抗菌治疗及患者转归。
共确定19例病例，主要发生在神经创伤患者和神经外科患者中。阴沟肠杆菌是最常分离出的肠杆菌属菌种，其次是产气肠杆菌和聚团肠杆菌（分别占培养物的50%、34%和16%）。总体而言，47%的患者实现了临床治愈/改善，死亡率为21%。抗生素治疗差异很大，包括第三代头孢菌素、静脉和鞘内注射氨基糖苷类、甲氧苄啶-磺胺甲恶唑（TMP-SMX）、哌拉西林、环丙沙星及其他各类抗生素。TMP-SMX治疗与较高的临床治愈/改善率相关，而第三代头孢菌素疗效较差。
肠杆菌性脑膜炎是神经损伤的一种罕见并发症。治疗常因肠杆菌属对第三代头孢菌素耐药而变得复杂。我们的结果表明，虽然第三代头孢菌素不是治疗肠杆菌性脑膜炎的最适宜药物选择，但TMP-SMX可能会产生满意的结果。
