Management And Outcomes Of Acinetobacter Baumanni Meningitis In Post-Neurosurgical Patients At Inkosi Albert Luthuli Central Hospital.

Abstract

Objectives: Acinetobacter baumannii meningitis is associated with increased morbidity and mortality in patients who have undergone neurosurgical procedures. The aims of the study were to describe the clinical characteristics and treatment options in patients diagnosed with this specific type of nosocomial meningitis/ventriculitis, evaluate the antimicrobial susceptibility pattern of Acinetobacter isolates and to identify factors associated with poor outcomes. Methods: A retrospective study of 47 patients who were treated for post-neurosurgical Acinetobacter baumannii meningitis/ventriculitis at a single neurosurgical unit in Kwazulu-Natal, South Africa from August 2016 to August 2022, was performed. Data collected and recorded included patient demographics, co-morbidities, clinical presentation, neurosurgical pathology, length of hospital stay, laboratory-based cerebrospinal fluid (CSF) analyses, antimicrobial susceptibility, and patient mortality. Results: The mean age at presentation was 27 years old with 74% of the patients being of male gender.  Eight (17%) patients had immunosuppressive medical co-morbidities. Primary neurosurgical pathologies included traumatic brain injury (60%), tumours (21%), hydrocephalus (11%), sepsis (4%) and vascular pathologies (4%). The average length of hospital stay was 64 days.  Multidrug-resistant Acinetobacter baumanii was cultured in 74% of these patients, most of whom were treated with either intravenous or intrathecal Colistin. The overall in-patient mortality rate was 49%. Conclusion: Neurosurgical patients who contract nosocomial Acinetobacter baumannii meningitis/ventriculitis post-neurosurgery have a high mortality. Most of the Acinetobacter baumanni isolates were multi-drug resistant and bear a poor prognosis. Early diagnosis, meticulous infection control measures and prompt initiation of directed antimicrobial therapy can assist in preventing this devastating complication.