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- W1026165784 abstract "OBJECTIVE: Successful management of Enterobacter aerogenes meningitis with intraventricular tobramycin in conjunction with systemic antibiotics. BACKGROUND: Intraventricular antibiotic administration has been utilized for complicated cases of meningitis especially with multi-drug resistant bacteria. Penetration of parenterally administered antibiotics into the cerebrospinal fluid (CSF) is low and higher drug concentrations can be achieved by direct instillation into the CSF compartment. DESIGN/METHODS: We report a case of Enterobacter aerogenes meningitis treated with intraventricular as well as systemic Tobramycin. Intraventricular Tobramycin was administered via external ventricular drain (EVD) for daily instillation of antibiotics and CSF sampling. The patient underwent serial brain MRIs. RESULTS: 46-year-old male with right temporal anaplastic astrocytoma, treated with concurrent chemoradiation and 8 cycles of adjuvant Temozolamide. Thereafter, the patient was diagnosed with tumor progression and underwent surgical resection. Three weeks after surgery, he acutely developed headaches, confusion and vomiting. Neurological exam was consistent with meningitis. CSF analysis revealed white cell count of 20,432, glucose less than 20, elevated protein of 834 and culture was positive for Enterobacter Aerogenes sensitive to Tobramycin. Brain MRI showed a right frontal lobe abscess. He was initiated on intraventricular tobramycin in conjunction with systemic tobramycin and meropenem. CSF cultures cleared on the third day and he received a total of 10 days of intraventricular tobramycin, 17 days of systemic tobramycin and 6 weeks of meropenem. EVD was removed after 10 days with no complications during or after intraventricular therapy. Brain MRI four weeks later showed resolution of abscess. CONCLUSIONS: Nosocomial bacterial meningitis poses a challenge in terms of management, as frequently multidrug resistant bacteria are causative agents. Our patient developed Enterobacter aerogenes meningitis as a complication of recent craniotomy. Although optimal management for these life threatening infections is not well defined, a multidisciplinary approach can help tailor timely, effective and aggressive antibacterial strategy. Disclosure: Dr. Gatson has nothing to disclose. Dr. Mella has nothing to disclose. Dr. Johnson has nothing to disclose. Dr. Ponce Mejia has nothing to disclose. Dr. Loghin has nothing to disclose." @default.
- W1026165784 created "2016-06-24" @default.
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- W1026165784 date "2015-04-06" @default.
- W1026165784 modified "2023-09-27" @default.
- W1026165784 title "Intraventricular tobramycin for bacterial meningitis (P5.115)" @default.
- W1026165784 hasPublicationYear "2015" @default.
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