Drug-resistant post-neurosurgical nosocomial Acinetobacter baumannii meningitis in two Iranian hospitals

Abstract

Acinetobacter baumannii may cause meningitis and ventriculitis, particularly after head trauma and/or neurosurgery. The rate of multidrug-resistant Acinetobacter meningitis has increased over the past years. This study was conducted to determine prevalence of drug-resistant post-neurosurgical nosocomial A. baumannii meningitis. During the period of study between 2007 and 2009, a total of 39 patients with positive culture of A. baumannii in their cerebrospinal fluid were evaluated. Standard bacteriological methods were used for identification of A. baumannii. The method which has been recommended by Clinical Laboratory and Standards Institute (CLSI) was applied to determine susceptibility and resistant pattern. All patients had a history of neurosurgical intervention and more than half of them stayed in the intensive care units (ICU) at the time of isolation. The highest rate of resistant pattern accounted for the third generation cephalosporins, followed by ciprofloxacin, amikacin, gentamicin and co-terimoxazole. Of all the isolates, 39% were resistant to imipenem and 15.5% to meropenem. The majority of carbapenem-resistant isolates were resistant to at least three other antibiotic classes. The emergence of postsurgical multi-drug resistant Acinetobacter meningitis highlights the importance of implementing preventative strategies towards nosocomial infections.

Key words: Acinetobacter baumannii, resistance, meningitis, neurosurgery.