Background
Methods
Results
Case | Gender | Age (years) | Underlying condition | Initial pathogen(s) | Antibiotics | Management | Interval* (days) | New presentation | New pathogen(s) | Antibiotics | Management | Survived |
---|---|---|---|---|---|---|---|---|---|---|---|---|
More than 7 days interval* | ||||||||||||
Gram (+) → G (-) or G (-) → G (+) | ||||||||||||
1 | M | 55 | Infarct, craniectomy, EVD |
Staphylococcus aureus
§
| LZD+EPM | Removed EVD → new EVDs | 61 | Fever, leukocytosis, CSF pleocytosis | ESBL-Escherichia coli
| MEP | Removed EVD | No |
2 | F | 48 | SICH, craniectomy, EVD |
Staphylococcus aureus
§
| VA+CAZ | Removed EVD → craniotomy, new EVDs | 34 | Fever, hydrocephalus |
Stenotrophomonas maltophilia
#
| MOX+TMP+ TIG+ ATM | Removed EVD → New EVD → removed EVD → VP shunt | Yes |
3 | F | 55 | DM, SICH, craniotomy, VPS |
Staphylococcus aureus
§
| VA | Removed VPS, debridement → new EVD | 11 | Fever, CSF pleocytosis |
Acinetobacter baumannii
| LZD+MEP | New EVD → ventriculo-pleural shunt | Yes |
4 | F | 41 | SICH, craniectomy, EVD |
Staphylococcus epidermidis
§
| VA | Craniotomy, EVD → VPS | 47 | No |
Enterobacter cloacae + Pseudomonas aeruginosa
| CAZ | Removed VPS | No |
5 | M | 73 | TICH, craniectomy, EVD (removed) | Coagulase-negative staphylococci§
| VA | New EVD | 9 | Fever, seizure, altered consciousness |
Enterobacter cloacae
| ROC | Removed EVD → VP shunt | Yes |
6 | M | 46 | TICH, craniectomy, VPS | Coagulase-negative staphylococci§
| VA | Externalisation VPS → removed VPS → new EVDs | 46 | Fever | Coagulase-negative staphylococci§ + Acinetobacter baumannii
| MEP | Removed EVD → new EVDs → VP shunt | Yes |
7 | M | 34 | Hydrocephalus, VPS |
Staphylococcus epidermidis
§
| VA | Removed VPS, New EVDs | 28 | Fever, CSF pleocytosis |
Acinetobacter spp
| CEF | Removed EVD → New EVD → removed → VPS | Yes |
8 | F | 45 | Lung cancer, meningeal metastasis, Omaya implant, infection | Coagulase-negative staphylococci§
| VA | Debridement, removed Omaya implant | 42 | Fever |
Acinetobacter spp
| CAZ | Yes | |
9 | F | 48 | Brain tumor, SICH, craniectomy |
Pseudomonas aeruginosa
| CEF | New EVD | 14 | No |
Enterococcus spp
| AMP+CEF | New EVD → Removed EVD | Yes |
10 | M | 67 | DM, SICH, VPS, craniotomy, EVD |
Acinetobacter baumannii
| MEP | Removed VPS, new EVDs | 41 | Fever |
Staphylococcus aureus
§
| VA | Removed EVD | No |
Gram (-) → G (-) | ||||||||||||
11A | M | 45 | Brain tumor, SICH, craniectomy, VPS |
Serratia marcescens
@
| MEP | Removed VPS, new EVD | 29 | Fever, reduced CSF glucose |
Stenotrophomonas maltophilia
| MOX+TMP | Removed EVD → new EVD | Treated |
11B | 90 | No |
Candida glabrata
| FLU+AMB | Treated | |||||||
11C | 48 | Fever |
Stenotrophomonas maltophilia
#
| TMP+TIG | No | |||||||
12 | M | 25 | TICH, craniectomy, EVD |
Pseudomonas aeruginosa
| CAZ | New EVDs | 37 | No |
Pseudomonas aeruginosa + ESBL-Proteus mirabilis
| MEP | Removed EVD | Yes |
13 | M | 25 | TICH, craniotomy, VPS |
Pseudomonas putida
| CAZ | Removed VPS, new EVD | 23 | Leukocytosis |
Acinetobacter spp
@
| MEP+SBM | Removed EVD → New EVDs → VPS | Yes |
14 | M | 64 | SICH, VPS |
Serratia marcescens
| VA + MEP | Removed VPS → new EVD | 8 | Fever, altered consciousness, hydrocephalus |
Acinetobacter baumannii
@
| MEP+SBM+ TIG+CST | Removed EVD → new EVDs → VP shunt | Yes |
15A | F | 71 | Old meningitis, hydrocephalus, VPS |
Morganella morganii
| CAZ | Externalization VPS→ removed → new VPS | 47 | Fever |
Proteus mirabilis
@
| MEP | Removed VPS | Treated |
15B | 40 | Fever | Glucose non-fermenting bacilli@
| MEP+SBM | Scalp debridement → VPS | Yes | ||||||
16 | M | 31 | TICH, craniotomy, EVD (removed) |
Stenotrophomonas maltophilia
| CAZ | New EVDs | 60 | Fever |
Stenotrophomonas maltophilia + Pseudomonas aeruginosa
| MEP+CIP | New EVDs → VPS → removed VPS → Omaya implant | Yes |
Others | ||||||||||||
17 | F | 58 | SICH, EVD |
Staphylococcus epidermidis
§+ Acinetobacter lwoffii
| VA+ROC+ CM | Removed EVD, new EVD | 28 | No |
Staphylococcus epidermidis
§+ Pseudomonas aeruginosa
| CAZ | Removed EVD → New EVD → VPS | Yes |
18A | M | 48 | TICH, craniectomy, EVD (removed) |
Escherichia coli
| MEP | New EVDs → craniotomy | 36 | Scalp wound infection |
Candida tropicalis
| FLU | removed EVD, debridement | Treated |
18B | 9 | No |
Escherichia coli+ Acinetobacter bauamnnii+ Enterococcus faecalis
| AMP | Debridement → new EVD | Treated | ||||||
18C | 11 | Fever |
Staphylococcus aureus
§+ Acinetobacter baumannii
| VA+IPM | Removed EVD, new EVD | Treated | ||||||
18D | 14 | Fever |
Stenotrophomonas maltophilia
| CIP | Removed EVD, new EVD → removed | Yes | ||||||
19 | M | 58 | Head injury | Viridan streptococci | VA+ROC | 8 | Hydrocephalus, ventriculitis, CSF pleocytosis |
Prevotella+ Veilonella+ Fusobacterium
| VA+ROC+ MET | New EVD | No | |
Less than 7 days interval | ||||||||||||
20 | F | 64 | DM, VHD, SICH, craniectomy, EVD |
Escherichia coli+ Enterococcus faecalis
| VA+CAZ | Removed EVD, New EVD | 3 | Fever, leukocytosis, CSF pleocytosis |
Enterobacter cloacae
#
@
| VA+CAZ | Removed EVD → VPS | No |
21 | M | 49 | Liver cirrhosis, SICH, craniectomy, EVD (removed) | Coagulase-negative staphylococci§
| VA | New EVD | 5 | No |
Enterobacter aerogenes
| CEF | New EVDs | No |
Case | Pathogens | ROC | CAZ | MAX | MEP | CIP | TIG | TMP-SMX | AMP- SBM |
---|---|---|---|---|---|---|---|---|---|
1 | ESBL-Escherichia coli
| R | R | R | S | S | |||
2 |
Stenotrophomonas maltophilia
| S | R | ||||||
R | R | ||||||||
3 |
Acinetobacter baumannii
| I | S | S | R | S | |||
S | S | R | R | S | |||||
4 |
Enterobacter cloacae
| S | S | S | |||||
Pseudomonas aeruginosa
| S | S | S | S | |||||
5 |
Enterobacter cloacae
| S | S | S | S | ||||
6 |
Acinetobacter baumannii
| S | S | S | S | ||||
I | S | S | S | ||||||
7 |
Acinetobacter spp
| I | S | S | S | S | S | ||
8 |
Acinetobacter spp
| S | S | S | S | S | S | ||
9 |
Pseudomonas aeruginosa
| S | S | S | S | ||||
R | S | S | |||||||
10 |
Acinetobacter baumannii
| S | S | S | S | ||||
11A |
Serratia marcescens
| I | R | R | S | ||||
Stenotrophomonas maltophilia
| S | S | |||||||
11C |
Stenotrophomonas maltophilia
| R | S | ||||||
12 |
Pseudomonas aeruginosa
| S | S | S | S | ||||
R | S | S | R | ||||||
ESBL-Proteus mirabilis
| R | R | S | S | R | ||||
13 |
Pseudomonas putida
| S | S | R | S | ||||
Acinetobacter spp
| R | R | R | I | R | S | I | ||
14 |
Serratia marcescens
| S | S | S | S | S | |||
Acinetobacter baumannii
| R | R | R | R | S | R | |||
15A |
Morganella morganii
| R | S | S | S | S | |||
Proteus mirabilis
| R | R | R | S | R | ||||
15B | Glucose non-fermenting bacilli | R | R | R | R | I | |||
16 |
Stenotrophomonas maltophilia
| S | S | ||||||
Pseudomonas aeruginosa
| R | R | S | S | |||||
17 |
Acinetobacter lwoffii
| S | S | S | |||||
Pseudomonas aeruginosa
| S | S | S | ||||||
18A |
Escherichia coli
| R | S | S | |||||
18B |
Acinetobacter baumannii
| R | I | S | R | R | |||
18D |
Stenotrophomonas maltophilia
| S | |||||||
19 |
Escherichia coli
| S | S | S | S | ||||
Enterobacter cloacae
| S | S | S | S | R | ||||
21 |
Enterobacter aerogenes
| I | I | S | S | S | |||
R | R | S | S | S |
Factors | Non-fatal | Fatal |
P
|
---|---|---|---|
(n = 14) | (n = 7) | ||
Age, median (range) | 48 (25 - 73) | 55 (41 - 67) | 0.400 |
Gender | |||
Male | 8 | 5 | 0.656 |
Female | 6 | 2 | |
Diabetes mellitus | |||
Yes | 1 | 2 | 0.247 |
No | 13 | 5 | |
Presence of new symptoms | |||
Yes | 10 | 5 | 1.000 |
No | 4 | 2 | |
Fever | |||
Yes | 10 | 4 | 0.638 |
No | 4 | 3 | |
Group | |||
G(+) > G (-) or G(+) > G(+) | 7 | 3 | 1.000 |
G(-) → G (-) | 5 | 1 | |
Intracranial hemorrhage (ICH) | |||
Spontaneous ICH | 4 | 4 | 0.085 |
Traumatic ICH | 6 | 0 |