Enterococcal meningitis/ventriculitis in Qatar-Experience with eight patients

Abstract

Background & objectives: Enterococcal meningitis/ventriculitis (EMV) is a relatively rare condition that usually affects patients with underlying diseases. This study was designed to describe the clinical profile, laboratory parameters, treatment, and outcomes of EMV in patients admitted to Hamad General Hospital, Qatar.

Methods and material: This retrospective hospital-based study described the patients with EMV from 2009 to 2013.

Results: Eight patients were recruited for the study. Their median age was 42 years (21.50-53.75 years). Six patients (75%) were males, and two (25%) were females. Fever was the most common presenting symptom being present in seven (87.5%) cases. Six patients (75%) had nosocomial EMV, and all acquired the infection after placement of an external ventricular drain (EVD). The isolated species include seven (87.5%) E. faecalis and one (12.5%) E. gallinarum, and all of them were sensitive to ampicillin and vancomycin. In all patients with nosocomial EMV, the infected EVDs were removed, and the eight patients received empirical antibiotics that were modified upon receipt of culture results. All patients were cured, and no mortality was reported.

Conclusions: EMV is a recognized complication related to the introduction of EVD, whereas community-acquired enterococcal meningitis was reported among children who had no established risk factors or immunosuppression. Because of its nonspecific clinical presentation, treating physicians should have a high suspicion index.

Keywords: meningitis; ventriculitis; external ventricular drain; Enterococcus species; ampicillin; and vancomycin.