Treatment against Post-operative Meningitis in the Neurosurgical Field

Abstract

Appropriate use of antimicrobials is strongly recommended in many fields, to prevent antimicrobial resistant strains. In the surgical field, it becomes important to reduce SSI (surgical site infection), from the view point of infection control, and also from the view point of a DRG-directed medical system. In this study, we focused on post-operative meningitis as neurosurgical SSI, and investigated the type of detected strains, antimicrobial susceptibility results, and treatment against the meningitis. In 39 cases of meningitis treated at our hospital between January 2001 and April 2004, 19 cases were meningitis occurring after neurosurgical interventions. Over 70% of these postoperative meningitis cases were caused by multi-drug resistant Staphylococcus strains such as coagulase-negative Staphylococcus (CNS) and methicillin-resistant Staphylococcus aureus (MRSA), and susceptibility test revealed that more than 40% of the CNS strains detected in the neurosurgical department were gentamycin (GM) registant strains. Contrary to this, from the susceptibility test against CNS detected in other departments, the rate of resistant strains was much lower than that found in the neurosurgical department. Infectious complications also become more important in neurosurgical field, and post-operative meningitis as SSI was caused mainly by low-toxic multidrug resistant strains such as CNS and MRSA. Lack of blood brain barrier (BBB) disruption in such cases indicates the difficulty of treating them only by intravenous administration of antimicrobials. Taken together, intrathecal vancomycin (VCM) administration must be considered as first choice treatment against post-operative meningitis in neurosurgical fields, and a Japanese guideline must be developed for the treatment against post-operative infectious complications such as meningitis.