Adult Enterobacter meningitis: A high incidence of coinfection with other pathogens and frequent association with neurosurgical procedures

Background: The clinical characteristics of Enterobacter infection in adult bacterial meningitis were defined. Patients and Methods: The clinical manifestations and therapeutic outcomes of ten adult patients with Enterobacter infections in acute bacterial menin gitis were analyzed. Results: Enterobacter infection was found in 4.5% (10/223) of our adult pat ients with culture-proven bacterial meningitis. The ten patients comprised seven men and three women aged between 16-69 years (mean 47 years). Coinfec tions with other pathogens were found in 50% of the cases, the most common pathogen being Klebsiella pneumoniae. Nine of the ten patients had a histor y of neurosurgery, and seven patients contracted the infection nosocomially . Multiple antibiotic-resistant strains, including resistance to third-gene ration cephalosporins, were found in three patients with polymicrobial infe ctions. These three patients received iv imipenem/cilastin therapy. The the rapeutic results showed that two of the ten patients died; five of the eigh t surviving patients had neurological sequelae. Conclusion: The predominant coinfection with Enterobacteriaceae in adult En terobacter meningitis may reflect the fact that most of the cases of polymi crobial Enterobacter infections have a potential gastrointestinal source. A postneurosurgical state was the most important predisposing factor for the development of Enterobacter infection in adult bacterial meningitis in our patients, The strains of the Enterobacter species in adult polymicrobial E nterobacter meningitis were commonly resistant to multiple antibiotics, inc luding third-generation cephalosporins. In Light of the high incidence of m ultiple antibiotic-resistant Enterobacter strains in adult polymicrobial En terobacter meningitis, the choice of initial empiric antibiotics may includ e carbapenem (imipenem/cilastin or meropenem). Although the mortality rate was not high in this group of patients, most survivors suffered neurologica l sequelae.