Spontaneous gram-negative meningitis: Difference between revisions
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* Most commonly caused by [[Escherichia coli]], [[Klebsiella pneumoniae]], [[Pseudomonas aeruginosa]], and [[Acinetobacter]] |
* Most commonly caused by [[Escherichia coli]], [[Klebsiella pneumoniae]], [[Pseudomonas aeruginosa]], and [[Acinetobacter]] |
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* Also [[Citrobacter]], [[Serratia marcescens]], [[Enterobacter]], and [[Proteus mirabilis]] |
* Also [[Citrobacter]], [[Serratia marcescens]], [[Enterobacter]], and [[Proteus mirabilis]] |
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* Typically excludes usual causes of meningitis such as [[Haemophilus]] or [[Neisseria]] |
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=== Risk Factors === |
=== Risk Factors === |
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|ESBL Gram-negative bacillus||[[meropenem]]||[[cefepime]] or a fluoroquinolone |
|ESBL Gram-negative bacillus||[[meropenem]]||[[cefepime]] or a fluoroquinolone |
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|''[[Haemophilus influenzae]]'' (β-lactamase negative)||[[ampicillin]]||third-generation cephalosporin, [[cefepime]], [[chloramphenicol]], or a fluoroquinolone |
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| rowspan="2" |7 days |
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|''[[Haemophilus influenzae]]'' (β-lactamase positive)||third-generation cephalosporin||[[cefepime]], [[chloramphenicol]], or a fluoroquinolone |
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[[Category:CNS infections]] |
[[Category:CNS infections]] |
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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 |
