This journal is
indexed in Scopus
Year 2015 Vol. 23 No 4
K.M. KUBRAKOV 1, V.M. SEMENOV 1, I.A. KOVALEVA 2
BETA-LACTAMASE LIQUOR ACTIVITY IN ACINETOBACTER PURULENT MENINGOENCEPHALITIS
EE "Vitebsk State Medical University"1
ME "Vitebsk Regional Clinical Hospital" 2
The Republic of Belarus
Objectives. To determine the role of Acinetobacter spp. in the development of purulent meningoencephalitis, to assess the level of beta-lactamase activity (BLA) of liquor and to analyze its clinical significance in neurosurgical patients.
Methods. Positive bacteriological liquor samples obtained from 52 patients with purulent meningoencephalitis of neurosurgery department of ME "Vitebsk Regional Clinical Hospital" in 2010-2015 have been studied. Identification and sensitivity of microorganisms were performed by test systems (ATB Expression Microbiological Culture Analyzer). To assess the beta-lactamase activity (BLA) of liquor the test system "Biolactam" (LTD "Sivital", the Republic of Belarus) was applied.
Results. Gram-positive flora composed 38,60% (95% CI: 25,56-51,63) out of 57 isolated strains, gram-negative microorganisms – 61.40% (95% CI: 48,37-74,44). Gram-positive flora was represented by native Staphylococcus 21,05%, (95% CI: 10,14-31,97) and the family Streptococcaseae 17,54% (95% CI: 7,36-27,73). The Gram-positive bacteria include A. baumannii – 36,84% (95% CI: 23,93-49,76), P. aeruginosa – 12.28% (95% CI: 3,49-21,07), K. pneumonia – 10 53% (95% CI: 2,53-18,74) and Cirtobacter – 1,75%.
The median of BLA of liquor (n=17) was equal to 41.82% (95% CI: 27,22-56,44); min 5,60%, max 78,29%. When A. baumannii (n=8), the value BLA of liquor was 43,01% (95% CI: 17,63%-68,49%). Pathogen was resistant to the third/fourth-generation cephalosporin and imipenem in 100% of cases; to meropenem and amikacin – in 83% of cases, to ofloxacin and ciprofloxacin – in 66%, to levofloxacin in 50%, to ampicillin/sulbactam in 0% of cases.
Conclusion. In the late postoperative period purulent meningoencephalitis is caused by gram-negative pathogens in 61,40% of cases. The common causative agent of purulent meningoencephalitis is considred to be A. baumannii (36,84%). The value BLA of liquor with A. baumannii (43,01%) is two folds higher than the threshold one (20%). This pathogen reveals high resistance to the third/fourth-generation cephalosporin, carbapenems and fluoroquinolones. High value of BLA of liquor is the guarantor of the pathogen resistance to antibacterial drugs.
- Starchenko AA, Khil'ko VA/red. Rukovodstvo po klinicheskoi neiroreanimatologii. Moscow, RF: Binom, 2013. 824 p.
- De Bels D, Korinek AM, Bismuth R, Trystram D, Coriat P, Puybasset L. Empirical treatment of adult postsurgical nosocomial meningitis. Acta Neurochir (Wien). 2002 Oct;144(10):989-95.
- McClelland S 3rd, Hall WA. Postoperative central nervous system infection: incidence and associated factors in 2111 neurosurgical procedures. Clin Infect Dis. 2007 Jul 1;45(1):55-9.
- Kubrakov KM, Semenov VM, Kovaleva IA, Zen'kova SK, Skvortsova VV. Antibiotikorezistennost' osnovnykh vozbuditelei gnoinykh meningitov u neirokhirurgicheskikh patsientov [Antibiotic resistance is the main pathogen of purulent meningitis in neurosurgical patients]. Novosti Khirurgii. 2013;21(6):78-83.
- Chang CJ, Ye JJ, Yang CC, Huang PY, Chiang PC, Lee MH. Influence of third-generation cephalosporin resistance on adult in-hospital mortality from post-neurosurgical bacterial meningitis. J Microbiol Immunol Infect. 2010 Aug;43(4):301-9. doi: 10.1016/S1684-1182(10)60047-3.
- Paramythiotou E, Karakitsos D, Aggelopoulou H, Sioutos P, Samonis G, Karabinis A. Post-surgical meningitis due to multiresistant Acinetobacter baumannii. Effective treatment with intravenous and/or intraventricular colistin and therapeutic dilemmas. Med Mal Infect. 2007 Feb;37(2):124-25.
- Kourbeti IS, Vakis AF, Ziakas P, Karabetsos D, Potolidis E, Christou S, Samonis GJ. Infections in patients undergoing craniotomy: risk factors associated with post-craniotomy meningitis. Neurosurg. 2015 May;122(5):1113-9. doi: 10.3171/2014.8.JNS132557.
- Yang M, Hu Z, Hu F. Nosocomial meningitis caused by Acinetobacter baumannii: risk factors and their impact on patient outcomes and treatments. Future Microbiol. 2012 Jun;7(6):787-93. doi: 10.2217/fmb.12.42.
- Briggs S, Ellis-Pegler R, Raymond N, Thomas M, Wilkinson L. Gram-negative bacillary meningitis after cranial surgery or trauma in adults. Scand J Infect Dis. 2004;36(3):165-73.
- Tuon FF, Penteado-Filho SR, Amarante D, Andrade MA, Borba LA. Mortality rate in patients with nosocomial Acinetobacter meningitis from a Brazilian hospital. Braz J Infect Dis. 2010 Sep-Oct;14(5):437-40.
- Moosavian M, Shoja S, Nashibi R, Ebrahimi N, Tabatabaiefar MA, Rostami S, Peymani A.Post Neurosurgical Meningitis due to Colistin Heteroresistant Acinetobacter baumannii. Jundishapur J Microbiol. 2014 Oct;7(10):e12287. doi: 10.5812/jjm.12287.
- Semenov VM, Zhil'tsov IV, Dmitrachenko TI, Zen'kova SK, Skvortsova VV, Kubrakov KM, Veremei IS. Vyiavlenie produktsii beta-laktamaz bakteriiami pri pomoshchi test-sistemy "Biolaktam" [Detection of beta-lactamase production by bacteria with a test system of "Biolaktam"]. Vestn Vitebsk Gos Med Uni-ta. 2014;13(4):84-89.
- Samaha-Kfoury JN, Araj GF. Recent developments in beta lactamases and extended spectrum beta lactamases. BMJ. 2003 Nov 22;327(7425):1209-13.
- Tängdén T, Enblad P, Ullberg M, Sjölin J. Neurosurgical gram-negative bacillary ventriculitis and meningitis: a retrospective study evaluating the efficacy of intraventricular gentamicin therapy in 31 consecutive cases. Clin Infect Dis. 2011 Jun;52(11):1310-6. doi: 10.1093/cid/cir197.
210023, Republic of Belarus,
g. Vitebsk, pr. Frunze, d. 27,
UO "Vitebskiy gosudarstvennyiy
kafedra nevrologii i neyrokhirurgii,
tel. office: 375 212 22-71-94,
Kubrakov Konstantin Mihaylovich
Kubrakov K.M. PhD, an associate professor of the neurology and neurosurgery chair of EE "Vitebsk State Medical University".
Semenov V.M. MD, professor, a head of the infectious diseases chair of EE "Vitebsk State Medical University".
Kovaleva I.A. A doctor-intern of ME "Vitebsk Regional Clinical Hospital".