Empirical treatment of adult postsurgical nosocomial meningitis.

摘要: Background: The combination of cefotaxime and fosfomycin (CTX-FOS) has been proposed in France for the empirical treatment postoperative nosocomial meningitis since late 1980s. purpose this work was to evaluate strategy today, as well other possible treatments.  Methods: Each patient undergoing a neurosurgical procedure prospectively included database designed surveillance surgical site infection (SSI). For each detected, we analysed vitro susceptibility causative micro-organisms alone (CTX), cefotaxime-fosfomycin (CTX-FOS), vancomycin (VAN) cefotaxime-vancomycin (CTX-VAN) combinations. population divided into two groups according presence or absence CSF shunting material.  Findings: 116 patients had meningitis/ventriculitis during last 36 months, among 6447 neurosurgery our department (1.8%). Ten aseptic (8.6%). Overall sensitivity CTX 69.8%, compared 77.3% with CTX-FOS (NS). This result due large proportion resistant cocci population. CTX-VAN increased overall up 91.5%, but benefit only significant material patients. In these latter patients, VAN effective combination.  Interpretation: is no longer best choice post meningitis. can be safely used without shunt; those either ventriculostomy shunt associated ventriculitis, could improve efficacy, provided that high doses are ensure correct diffusion.