Spontaneous gram-negative meningitis
From IDWiki
Background
Microbiology
- Most commonly caused by Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter
- Also Citrobacter, Serratia marcescens, Enterobacter, and Proteus mirabilis
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 | |
| Haemophilus influenzae (β-lactamase negative) | ampicillin | third-generation cephalosporin, cefepime, chloramphenicol, or a fluoroquinolone | 7 days |
| Haemophilus influenzae (β-lactamase positive) | third-generation cephalosporin | cefepime, chloramphenicol, or a fluoroquinolone |
