| Summary: | 碩士 === 高雄醫學大學 === 藥學研究所碩士在職專班 === 92 === Previously, adult bacterial meningitis infection due to
Acinetobacter species is uncommonIn recent years, the
incidence of adult meningitis due to Acinetobacter species
infection is increasing, especially in those patients with
post-neurosurgical state. With rare exception, most of the
adult cases of Acinetobacter species meningitis develop
nosocomially. The pharmacological characteristics of
Acinetobacter baumannii strains isolated from CSF of adult
meningitis patients produced initial multi-resistant rapidly.
These characteristics have caused a therapeutic challenge in
the choice of initial empiric antibiotics or the use of
antibiotics for maintenance therapy.
We conduct this study from 1998 to 2003 totally eighteen
patients, including twenty-one of the Acinetobacter strains
isolated from CSF specimens of adult patients with meningitis
to examine the antibiotics MIC data. The antibiotics used in
this study are those that physicians usually used to treat adult
bacterial Acinetobacter meningitis, and they include
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ceftazidime, ceftriaxone, cefepime, imipenem, meropenem,
aztreonam, ciprofloxacin and ampicillin/sulbactam. In this
study,the results of in vitro activity show these antibiotics
MIC data : imipenem MIC90% : 2, meropenem MIC90% : 4, cefepime
MIC90% :>16, ceftriaxone >64, ceftazidime MIC90% :>128. From
these datas, carbapenem are better choice than the third and
fourth cephalosporins. Among the carbapenem (imipenem,
meropenem ), imipenem had more tendency to induce seizure
attack in therapeutic dose than meropenem. We suggest meropenem
as empiric antibiotic to treat nosocomially-infected
post-neurosurgical Acinetobacter meningitis. And then
according to culture result choosing antibiotc for maintenance
therapy. Despite the prognosis of other adult bacterial
meningitis can be influenced by many factors. The result of this
study, we do not find any significant factors including
underlying diseases or clinical signs that increase patient’s
mortality. This study may let the physicans have a better
understanding in choosing a proper antibiotic for the
management of adult Acinetobacter meningitis and improve the
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therapeutic result of this potentially fatal CNS infection.
Besides, if the medical care after surgery procedure can be well
controlled to prevent the Acinetobacter infection , that will
save a lot of medical costs.
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