Etiological structure and antibacterial therapy of purulent meningitis in neurological patients

Abstract

Purulent meningitis is one of the most severe forms of inflammatory brain lesions. Mortality rate in purulent meningitis amounts 10.0-25.0%.

Aim. To study the etiological structure and resistance to antibacterial drugs, to optimize the algorithm of etiotropic therapy of purulent meningitis in neurological patients.

Materials and Methods. The data on etiology and resistance of causative agents of purulent meningitis in 54 neurological patients (28 of them are male; the average age is 47 (33.5; 58) years) for the period of 2010-2018 are presented in the article. The cerebrospinal fluid (CSF) study included general, biochemical, bacteriological analyses as well as the study of the D-lactate level. Identification of microorganisms and determination of resistance to antibacterial therapy was performed using identification test systems (ID) and strips (ATB) using the automatic microbiological analyzer ATB Expression (Bio Merieux, France). The combined test BD Directigen Meningitis Combo Test (Becton Dickinson, USA) was also used for the direct quantitative determination of antigens against H. influenzae, S. pneumoniae, N. meningitidis, E. coli. Statistical processing of the results was performed using Statistica 10.0 (Stat Soft Inc., USA) with the calculation of the sign frequency, 95.0% confidence interval (95.0% CI), median, upper and lower quartiles (Me [LQ; UQ]).

Results. 83.33% of meningitis cases in neurological patients have been established to be manifested by purulent inflammatory processes, which is confirmed by the results of the CSF analysis and the level of D-lactate (p<0.05) in it. The inoculability of pathogens from CSF was 61.90% (95.0% CI 46.59-77.22%). At the same time, microorganisms were isolated in the monoculture. Gram-positive microflora constituted 88.46% (95.0% CI 75.30-100.0%) among the isolated pathogens. The main pathogens of purulent meningitis in the studied patients’ sample were Str. pneumoniae (34.62%) and S. aureus (26.92%); 96.15% of the isolated strains are sensitive to the most commonly used antibacterial drugs to treat meningitis.

Conclusions. The etiological structure of purulent meningitis in neurological patients has been established. The resistance of pathogens to antibacterial drugs has been studied. The algorithm of etiotropic antibacterial therapy has been optimized.

Keywords

meningitis / neurology / antibiotics / antibacterial therapy / community-acquired infection / Pneumococcus / Staphylococcus aureus

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Kubrakov K.M., Semenov V.M., Marshalko O.V., Migunova V.A.