Postsurgical meningitis due to Acinetobacter baumannii: study of 22 cases and review of the literature

Background. Postsurgical Acinetobacter baumannii meningitis is associated w ith relevant morbidity and mortality. It has been related to neurosurgery, intraventricular catheters (IC) or CSF fistula. Thus, features, epidemiolog y and clinical course of this infection were studied. Methods. Retrospective analysis of 22 episodes of nosocomial postsurgical A cinetobacter baumannii meningitis. Twenty episodes occurred in males. The m ean age of patients was 46 years (range: 16-83 years). Results. All patients were admitted to the ICU. In 50% of patients a histor y of intraventricular hemorrhage was recorded, 36% had had a skull fracture and the remaining patients had a brain tumor. In IS cases the portal of en try was considered to be IC, in two an epidural catheter, and in two a CSF fistula. Patients shoed a clinical picture indistinguishable from other typ es of meningitis, fever being the most common symptom (100%). CSF findings were consistent with bacterial meningitis. In one case the microorganism wa s recovered from blood. Fifteen patients recovered, three died as a direct result of the infection, and the remaining patients relapsed. Non recovery of patients was significantly associated with non removal of catheter (p < 0.05). Conclusions. Postsurgical Acinetobacter baumannii meningitis occurs frequen tly in patients previously colonized with this microorganism in other sites and is enhanced by the presence of an IC. Catheter removal is essential fo r recovery of patients.