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Abstract

Post-operative meningitis (POM) is a life-threatening complication of neurosurgery. Diagnosis is often difficult due to pre-existing inflammation and antecedent antimicrobial use. Bacterial cerebrospinal fluid (CSF) cultures may reveal no growth, but empiric antibiotics are typically given due to the high morbidity and mortality associated with POM. 16S rRNA gene PCR/sequencing is a molecular methodology that can identify the presence of bacteria regardless of viability for culture.

A patient presented with a rapid onset of fever associated with headache, neck pain, nausea and altered mental status 11 days after undergoing laser interstitial thermal therapy for treatment of recurrent astrocytoma at another hospital. Based on clinical presentation and imaging, POM was suspected, and empiric antibacterial therapy was started. Microbiological stains and cultures of CSF were negative. Due to persistent fevers, 16S rRNA gene PCR/sequencing was done on CSF; it detected a member of the order most closely resembling species. All antimicrobials were stopped except for cefepime, which was given for 2 weeks. The patient’s mental status fully recovered.

The application of 16S rRNA gene PCR/sequencing in the setting of POM is of value by improving the quality of patient care and decreasing costs by antimicrobial de-escalation. Further studies regarding the positive and negative predictive values of this test are required.

  • This is an open-access article distributed under the terms of the Creative Commons Attribution License.
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2020-02-03
2024-12-09
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References

  1. van Overbeek EC, Janknegt R, Ter Berg HWM, Top J, Sportel E et al. Failure of vancomycin treatment for meningitis caused by vancomycin-susceptible Enterococcus faecium . Scand J Infect Dis 2010; 42:794–796 [View Article]
    [Google Scholar]
  2. Blomstedt GC. Post-Operative aseptic meningitis. Acta Neurochir 1987; 89:112–116 [View Article]
    [Google Scholar]
  3. Druel B, Vandenesch F, Greenland T, Verneau V, Grando J et al. Aseptic meningitis after neurosurgery: a demonstration of bacterial involvement. Clin Microbiol Infect 1996; 1:230–234 [View Article]
    [Google Scholar]
  4. Forgacs P, Geyer CA, Freidberg SR. Characterization of chemical meningitis after neurological surgery. Clin Infect Dis 2001; 32:179–185 [View Article]
    [Google Scholar]
  5. Heath PT. Neonatal meningitis. Archives of disease in childhood - Fetal and neonatal edition; 2003; 88173F–178
  6. du Plessis M, Smith AM, Klugman KP. Rapid detection of penicillin-resistant Streptococcus pneumoniae in cerebrospinal fluid by a seminested-PCR strategy. J Clin Microbiol 1998; 36:453–457 [View Article]
    [Google Scholar]
  7. Gomez E, Cazanave C, Cunningham SA, Greenwood-Quaintance KE, Steckelberg JM et al. Prosthetic joint infection diagnosis using broad-range PCR of biofilms dislodged from knee and hip arthroplasty surfaces using sonication. J Clin Microbiol 2012; 50:3501–3508 [View Article]
    [Google Scholar]
  8. Virk A, Pritt B, Patel R, Uhl JR, Bezalel SA et al. Mycobacterium lepromatosis lepromatous leprosy in US citizen who traveled to disease-endemic areas. Emerg Infect Dis 2017; 23:1864–1866 [View Article]
    [Google Scholar]
  9. Zarrouk V, Vassor I, Bert F, Bouccara D, Kalamarides M et al. Evaluation of the management of postoperative aseptic meningitis. Clin Infect Dis 2007; 44:1555–1559 [View Article]
    [Google Scholar]
  10. Grimwood K, Anderson P, Anderson V, Tan L, Nolan T. Twelve year outcomes following bacterial meningitis: further evidence for persisting effects. Arch Dis Child 2000; 83:111–116 [View Article]
    [Google Scholar]
  11. Srinivasan L, Pisapia JM, Shah SS, Halpern CH, Harris MC. Can broad-range 16S ribosomal ribonucleic acid gene polymerase chain reactions improve the diagnosis of bacterial meningitis? A systematic review and meta-analysis. Ann Emerg Med 2012; 60:609–620 [View Article]
    [Google Scholar]
  12. Meddeb M, Koebel C, Jaulhac B, Schramm F. Comparison between broad-range real-time and a broad range end-point PCR assays for the detection of bacterial 16S rDNA in clinical samples: a 1-year prospective study in routine practice at the university hospital of Strasbourg, France. Am J Clin Pathol 2014; 142:A163 [View Article]
    [Google Scholar]
  13. Hussein K, Bitterman R, Shofty B, Paul M, Neuberger A. Management of post-neurosurgical meningitis: narrative review. Clin Microbiol Infect 2017; 23:621–628 [View Article]
    [Google Scholar]
  14. Banks JT, Bharara S, Tubbs RS, Wolff CL, Gillespie GY et al. Polymerase chain reaction for the rapid detection of cerebrospinal fluid shunt or ventriculostomy infections. Neurosurgery 2005; 57:1237–1243 [View Article]
    [Google Scholar]
  15. Dayal R, Kashyap H, Pounikar G, Kamal R, Yadav NK et al. Real time PCR in childhood tuberculosis: a valuable diagnostic tool. Indian J Pediatr 2015; 82:189–191 [View Article]
    [Google Scholar]
  16. Brink M, Welinder-Olsson C, Hagberg L. Time window for positive cerebrospinal fluid broad-range bacterial PCR and Streptococcus pneumoniae immunochromatographic test in acute bacterial meningitis. Infect Dis 2015; 47:869–877 [View Article]
    [Google Scholar]
  17. Rafi W, Chandramuki A, Mani R, Satishchandra P, Shankar SK. Rapid diagnosis of acute bacterial meningitis: role of a broad range 16S rRNA polymerase chain reaction. J Emerg Med 2010; 38:225–230 [View Article]
    [Google Scholar]
  18. Tunkel AR, Hasbun R, Bhimraj A, Byers K, Kaplan SL et al. 2017 infectious diseases Society of America's clinical practice guidelines for healthcare-associated ventriculitis and meningitis. Clin Infect Dis 2017; 64:e34–e65 [View Article]
    [Google Scholar]
  19. Singhi SC, Mohankumar D, Singhi PD, Sapru S, Ganguly NK. Evaluation of polymerase chain reaction (PCR) for diagnosing Haemophilus influenzae b meningitis. Ann Trop Paediatr 2002; 22:347–353 [View Article]
    [Google Scholar]
  20. O'Leary JJ, Engels K, Dada MA. The polymerase chain reaction in pathology. J Clin Pathol 1997; 50:805–810 [View Article]
    [Google Scholar]
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