Non-cephalosporin-susceptible, glucose non-fermentative Gram-negative bacilli meningitis in post-neurosurgical adults: Clinical characteristics and therapeutic outcome

ObjectiveThe clinical and laboratory characteristics of non-cephalosporin-susceptible (non-CS) glucose non-fermentative Gram-negative (G(−)) infections in adults with postneurosurgical meningitis are rarely examined solely in the literature.MethodsThe data of 28 post-neurosurgical adults meningitis with glucose non-fermentative G(−) infections, collected during a study period of 5 years (2006–2010), were reviewed. The clinical and laboratory data between the non-cephalosporin-susceptible groups and the cephalosporin-susceptible groups were compared.ResultsA total of 30 G(−) strains were collected from the 28 enrolled cases. Among the implicated glucose non-fermentative G(−) strains, 18 strains, belonging to 17 cases, were non-CS. Among the 18 non-cephalosporin-susceptible strains, Acinetobacter spp. (39%, 7/18) was the most common, followed by Pseudomonas spp. (22%, 4/18), Stenotrophomonas maltophilia (22%, 4/18) and Elizabethkingia meningoseptica (11%, 2/18). With a comparative analysis, there were no significant difference between the non-cephalosporin-susceptible and cephalosporin-susceptible glucose non-fermentative G(−) groups. The clinical and laboratory data were also of no statistical significance between the fatal (n = 4) and non-fatal (n = 13) non-cephalosporin-susceptible groups.ConclusionSixty percent (18/30) of implicated glucose non-fermentative G(−) strains of post-NS meningitis in adults are non-cephalosporin-susceptible. Among the non-cephalosporin-susceptible glucose non-fermentative G(−) strains, Acinetobacter spp., Pseudomonas spp., S. maltophilia and E. meningoseptica are the commonly implicated pathogens, and their emergence in this specific group of meningitis has caused a therapeutic dilemma. The clinical manifestations of non-cephalosporin-susceptible glucose non-fermentative G(−) meningitis were not unique; therefore, only bacterial culture and antimicrobial susceptibility test are the methods for identification confirmation.