Resistance to third-generation cephalosporins in adult gram-negative bacillary meningitis

Ninety-three patients with gram-negative bacillary meningitis (GNBM) were i dentified at Kaohsiung Chang Gung Memorial Hospital, over a period of 12 ye ars. Among them, eight showed resistance to third-generation cephalosporins , accounting for 9% of the total GNBM cases and 29% of the postneurosurgica l GNBM cases. The resistant pathogens included Acinetobacter baumannii, Kle bsiella pneumoniae, Citrobacter freundii and Morganella morganii. These eig ht patients, sis males and two females aged 18-61 years, all had nosocomial ly acquired meningitis associated with head trauma and/or postneurosurgical states. Six patients received imipenem/cilastatin treatment; five survived and one died. The other two expired because they did not receive appropria te antibiotic treatment. Although third-generation cephalosporin-resistant GNBM is rare, its Incidence has been increasing over the past 5 years. In p atients with nosocomially-acquired postneurosurgical GNBM, the presence of third-generation cephalosporin resistance should therefore be highly suspec ted. The appropriate choice of antibiotic is essential for their survival.