Clinical Characteristics and Antimicrobial Therapy of Healthcare-associated Carbapenem-non-susceptible Gram-negative Bacterial Meningitis: a 16-year Retrospective Cohort Study

Overview

Journal BMC Infect Dis

Publisher Biomed Central

Specialty Infectious Diseases

Date 2024 Apr 2

PMID 38566040

Authors

Jiyan Xu

Xiaoling Du

Dan Li

Pei Li

Qinglan Guo

Xiaogang Xu

Fupin Hu

Minggui Wang

Affiliations

Soon will be listed here.

Abstract

Objective: Healthcare-associated Gram-negative bacterial meningitis is a substantial clinical issue with poor outcomes, especially for neurosurgical patients. Here, we aimed to study the characteristics and treatment options of patients with healthcare-associated carbapenem-non-susceptible (Carba-NS) Gram-negative bacterial meningitis.

Methods: This observational cohort study was conducted at a teaching hospital from 2004 to 2019. The clinical characteristics of patients with meningitis with Carba-NS and carbapenem-susceptible (Carba-S) bacilli were compared, and the antimicrobial chemotherapy regimens and outcomes for Carba-NS Gram-negative bacterial meningitis were analyzed.

Results: A total of 505 patients were included, of whom 83.8% were post-neurosurgical patients. The most common isolates were Acinetobacter spp. and Klebsiella spp., which had meropenem-resistance rates of 50.6% and 42.5%, respectively, and showed a markedly growing carbapenem-resistance trend. Kaplan-Meier curve analysis revealed that Carba-NS Gram-negative bacilli were associated with a significantly higher in-hospital mortality rate (18.8%, 35/186) compared to the Carba-S group (7.4%, 9/122; P = 0.001). For Carba-NS Enterobacterales meningitis, aminoglycoside-based and trimethoprim-sulfamethoxazole-based regimens yielded significantly higher clinical efficacy rates than non-aminoglycoside-based and non-trimethoprim-sulfamethoxazole-based regimens (69.0% vs. 38.7%, P = 0.019 and 81.8% vs. 46.9%, P = 0.036, respectively). For Carba-NS A. baumannii complex meningitis, tetracycline-based (including doxycycline, minocycline, or tigecycline) therapy achieved a significantly higher clinical efficacy rate (62.9%, 22/35) than the non-tetracycline-based therapy group (40.4%, 19/47; P = 0.044).

Conclusions: Our findings revealed that Carba-NS Gram-negative bacilli are associated with higher in-hospital mortality in patients with healthcare-associated meningitis. The combination therapies involving particular old antibiotics may improve patients' outcome.

Trial Registration: This study was registered on the Chinese Clinical Trial Register under ChiCTR2000036572 (08/2020).

Citing Articles

Comparative analysis of clinical characteristics and outcomes between carbapenem-resistant and carbapenem-sensitive infections: insights from a tertiary hospital in Northern China.

Wang B, Zhang W, Zhang H, Li M, Zhang Z, Peng X Front Med (Lausanne). 2025; 12:1499057.

PMID: 39975685 PMC: 11836024. DOI: 10.3389/fmed.2025.1499057.

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