An updated approach to healthcare-associated meningitis

Abstract

Among hospital-associated infections, healthcare-associated central nervous system infections are quite important because of high morbidity and mortality rates. The causative agents of healthcare-associated meningitis differ according to the status of immune systems and underlying diseases. The most frequent agents are Gram-negative bacilli (Pseudomonas spp., Acinetobacter spp., Escherichia coli and Klebsiella pneumoniae) and Gram-positive cocci (Staphylococcus aureus and coagulase-negative staphylococci). There are currently several problems in the treatment strategies of healthcare-associated meningitis due to a globally increasing resistance problem. Strategies targeting multidrug-resistant pathogens are especially limited. This review focuses on healthcare-associated meningitis and the current treatment strategies with a particular focus on methicillin-resistant Staphylococcus aureus (MRSA) meningitis.

Keywords::

• Acinetobacter baumannii
• amikacin
• carbapenem-resistant
• cefepime
• ceftazidime
• colistin
• daptomycin
• Escherichia coli
• hospital acquired meningitis
• Klebsiella pneumoniae
• linezolid
• MDR
• meropenem
• methicillin-resistant Staphylococcus aureus
• nosocomial meningitis
• Pseudomonas aeruginosa
• teicoplanin
• therapy
• tigecycline
• treatment of hospital acquired meningitides
• vancomycin
• XDR

Financial & competing interests disclosure

OR Sipahi received speaker's honorarium from Novartis and Merck. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• In the case of methicillin-resistant Staphylococcus aureus meningitis, vancomycin is the mainstay therapy. Linezolid or teicoplanin or daptomycin may also be used as alternatives. In cases when vancomycin minimum inhibitory concentration values are >1 mg/l, linezolid can be especially preferred due to low vancomycin success rate.

• Linezolid, daptomycin or tigecycline combinations are the treatment options for vancomycin-resistant enterococcal meningitis.

• Ceftriaxone or cefotaxime may be used for susceptible Escherichia coli or Klebsiella pneumoniae strains.

• Ceftazidime or cefepime may be used in susceptible Pseudomonas spp. or Acinetobacter spp. strains. Meropenem can be chosen in cephalosporin-resistant bacterial meningitis. Finally, colistin may be preferred in cabapenem-resistant bacteria, while tigecycline, sulbactam intrathecal or intravenous aminoglycosides can also be used in carbapenem-resistant Acinetobacter depending on the susceptibility pattern of the infecting strain.