[Nosocomial staphylococcal meningitis].

OBJECTIVE

Clinical, bacteriological and therapeutically study on iatrogenic staphylococcal meningitis.

METHODS

Retrospective analysis of 33 cases of iatrogenic staphylococcal meningitis admitted to the Hospital of Infectious Diseases of Iaşi in the interval 1988-1997.

RESULTS

In the interval under study the recorded incidence was 1-5 cases per year. The predisposing factors were neurosurgical procedures for endocranial processes (12 cases), operated chronic otomastoiditis (11 cases), ventriculoatrial or peritoneal shunt (5 cases) and neurosurgical assessment (5 cases). The onset was slow, with persisting and mild headache persistence recurrence of fever, vomiting and convulsions followed by meningeal contracture and encephalitic phenomena. In 24 patients cerebrospinal fluid was typical for purulent meningitis. The causal agents were isolated in 25 cases being Staphylococcus aureus (20 cases) and Staphylococcus epidermidis sensitive to usual antistaphylococcal agents. Three therapeutically schemes were used the association cefotaxim î gentamycin proving to be the most effective vancomycin was required in but 2 cases. Three deaths were recorded.

CONCLUSIONS

The symptoms of iatrogenic staphylococcal meningitis are mild marked by the underlying disease the most effective treatment being the association of cefotaxim with an aminoglycoside.