Clinical characteristics and antimicrobial therapy of healthcare-associated carbapenem-non-susceptible gram-negative bacterial meningitis: a 16-year retrospective cohort study

• Published in: BMC infectious diseases Vol. 24; no. 1; pp. 368 - 13
• Main Authors: Xu, Jiyan, Du, Xiaoling, Li, Dan, Li, Pei, Guo, Qinglan, Xu, Xiaogang, Hu, Fupin, Wang, Minggui
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 02.04.2024; BioMed Central; BMC
• Subjects: Aminoglycoside antibiotics; Aminoglycosides; Anti-Bacterial Agents - therapeutic use; Anti-infective agents; Antibiotics; Antimicrobial agents; Antimicrobial therapy; Bacteria; Bacterial meningitis; Cancer; Carbapenem-resistance; Carbapenems; Carbapenems - therapeutic use; Care and treatment; Chemotherapy; Delivery of Health Care; Diagnosis; Dosage and administration; Doxycycline; Drug resistance in microorganisms; Effectiveness; Gram-negative bacilli; Gram-Negative Bacteria; Health aspects; Health care; Health care reform; Hospital costs; Hospitals; Humans; Imipenem; Infections; Klebsiella; Medical research; Medicine, Experimental; Meningitis; Meningitis, Bacterial - drug therapy; Meningitis, Bacterial - microbiology; Meropenem; Microbial Sensitivity Tests; Minocycline; Mortality; Neurosurgery; Observational studies; Pathogens; Patients; Prevention; Retrospective Studies; Risk factor; Risk factors; Success; Sulfamethoxazole; Tetracycline; Tetracyclines; Tigecycline; Trimethoprim; Trimethoprim-sulfamethoxazole; China; United States > US; Meningitis; Antimicrobial therapy; Gram-negative bacteria; Carbapenem-resistance; Risk factor
• ISSN: 1471-2334; 1471-2334
• DOI: 10.1186/s12879-024-09237-9

Healthcare-associated Gram-negative bacterial meningitis is a substantial clinical issue with poor outcomes, especially for neurosurgical patients. Here, we aimed to study the characteristics and treatment options of patients with healthcare-associated carbapenem-non-susceptible (Carba-NS) Gram-negative bacterial meningitis. This observational cohort study was conducted at a teaching hospital from 2004 to 2019. The clinical characteristics of patients with meningitis with Carba-NS and carbapenem-susceptible (Carba-S) bacilli were compared, and the antimicrobial chemotherapy regimens and outcomes for Carba-NS Gram-negative bacterial meningitis were analyzed. A total of 505 patients were included, of whom 83.8% were post-neurosurgical patients. The most common isolates were Acinetobacter spp. and Klebsiella spp., which had meropenem-resistance rates of 50.6% and 42.5%, respectively, and showed a markedly growing carbapenem-resistance trend. Kaplan-Meier curve analysis revealed that Carba-NS Gram-negative bacilli were associated with a significantly higher in-hospital mortality rate (18.8%, 35/186) compared to the Carba-S group (7.4%, 9/122; P = 0.001). For Carba-NS Enterobacterales meningitis, aminoglycoside-based and trimethoprim-sulfamethoxazole-based regimens yielded significantly higher clinical efficacy rates than non-aminoglycoside-based and non-trimethoprim-sulfamethoxazole-based regimens (69.0% vs. 38.7%, P = 0.019 and 81.8% vs. 46.9%, P = 0.036, respectively). For Carba-NS A. baumannii complex meningitis, tetracycline-based (including doxycycline, minocycline, or tigecycline) therapy achieved a significantly higher clinical efficacy rate (62.9%, 22/35) than the non-tetracycline-based therapy group (40.4%, 19/47; P = 0.044). Our findings revealed that Carba-NS Gram-negative bacilli are associated with higher in-hospital mortality in patients with healthcare-associated meningitis. The combination therapies involving particular old antibiotics may improve patients' outcome. This study was registered on the Chinese Clinical Trial Register under ChiCTR2000036572 (08/2020).