Spontaneous gram-negative meningitis: Difference between revisions
From IDWiki
No edit summary |
No edit summary |
||
| (One intermediate revision by the same user not shown) | |||
| Line 5: | Line 5: | ||
* Most commonly caused by [[Escherichia coli]], [[Klebsiella pneumoniae]], [[Pseudomonas aeruginosa]], and [[Acinetobacter]] |
* Most commonly caused by [[Escherichia coli]], [[Klebsiella pneumoniae]], [[Pseudomonas aeruginosa]], and [[Acinetobacter]] |
||
* Also [[Citrobacter]], [[Serratia marcescens]], [[Enterobacter]], and [[Proteus mirabilis]] |
* Also [[Citrobacter]], [[Serratia marcescens]], [[Enterobacter]], and [[Proteus mirabilis]] |
||
* Typically excludes usual causes of meningitis such as [[Haemophilus]] or [[Neisseria]] |
|||
=== Risk Factors === |
=== Risk Factors === |
||
| Line 21: | Line 22: | ||
* CNS dosed antibiotics to complete 21 days is typically sufficient |
* CNS dosed antibiotics to complete 21 days is typically sufficient |
||
{| class="wikitable sortable" |
|||
!Organism |
|||
!First-line |
|||
!Second-line |
|||
!Duration |
|||
|- |
|||
|''[[E. coli]]'' and other [[Enterobacteriaceae]]||third-generation cephalosporin||[[ampicillin]], [[meropenem]], [[aztreonam]], [[TMP-SMX]], or [[ciprofloxacin]] |
|||
| rowspan="3" |21 days |
|||
|- |
|||
|''[[Pseudomonas aeruginosa]]''||[[cefipime]] or [[ceftazidime]]||[[meropenem]], [[aztreonam]], or [[ciprofloxacin]] |
|||
|- |
|||
|ESBL Gram-negative bacillus||[[meropenem]]||[[cefepime]] or a fluoroquinolone |
|||
|} |
|||
[[Category:CNS infections]] |
[[Category:CNS infections]] |
||
Latest revision as of 16:27, 19 July 2023
Background
Microbiology
- Most commonly caused by Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter
- Also Citrobacter, Serratia marcescens, Enterobacter, and Proteus mirabilis
- Typically excludes usual causes of meningitis such as Haemophilus or Neisseria
Risk Factors
- Diabetes mellitus
- Cirrhosis
- End-stage renal disease
- Substance abuse, including alcohol use disorder
- Cancer
Clinical Presentation
- As per other forms of bacterial meningitis
Management
- CNS dosed antibiotics to complete 21 days is typically sufficient
| Organism | First-line | Second-line | Duration |
|---|---|---|---|
| E. coli and other Enterobacteriaceae | third-generation cephalosporin | ampicillin, meropenem, aztreonam, TMP-SMX, or ciprofloxacin | 21 days |
| Pseudomonas aeruginosa | cefipime or ceftazidime | meropenem, aztreonam, or ciprofloxacin | |
| ESBL Gram-negative bacillus | meropenem | cefepime or a fluoroquinolone |
