Clinical Neurology and Neurosurgery 115 (2013) 1709–1715 Contents lists available at ScienceDirect Clinical Neurology and Neurosurgery jou rn al h om epage: www.elsevier.com/locate/clineuro Clinical characteristics of Stenotrophomonas maltophilia meningitis in adults: A high incidence in patients with a postneurosurgical state, long hospital staying and antibiotic use Chi-Ren Huang a , Shu-Feng Chen a,b,1 , Nai-Wen Tsai a , Chiung-Chih Chang a,b , Chen-Hsien Lu a , Yao-Chung Chuang a , Chun-Chih Chien c , Wen-Neng Chang a,* a Department of Neurology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan b Department of Biological Science, National Sun Yat-Sen University, Kaohsiung, Taiwan c Department of Laboratory Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan a r t i c l e i n f o Article history: Received 13 February 2012 Received in revised form 15 February 2013 Accepted 25 March 2013 Available online 20 April 2013 Keywords: Meningitis Stenotrophomonas maltophilia Post-neurosurgical a b s t r a c t Objective: Stenotrophomonas (S.) maltophilia is an uncommon pathogen of adult bacterial meningitis (ABM). Methods: The clinical characteristics of six S. maltophilia ABM cases, collected during a study period of nine years (2001–2009) were included. In the related literature, 13 S. maltophilia ABM cases were reported, and their clinical data were also collected. Results: The 19 S. maltophilia ABM cases included 11 men and 8 women, aged 28–70 years. Of these 19 cases, 89.5% (17/19) had underlying neurosurgical (NS) conditions as the preceding event. Before the development of S. maltophilia ABM, 52.6% (10/19) of them had long stays in hospital and 63.2% (12/19) had undergone antibiotic treatment. Among the implicated S. maltophilia cases, three strains were found to have a resistance to sulfamethoxazole–trimethoprim (SMZ–TMP). Two of our five cases had resistant strains to levofloxacin. Among the antibiotics chosen for treatment, SMZ–TMP was the most common followed by quinolone (ciprofloxacin, levofloxacin, moxifloxacin). The therapeutic results showed 2 cases expired while the other 17 cases survived. Conclusions: S. maltophilia ABM usually develops in patients with a preceding neurosurgical condition, a long hospital stay and antibiotic use. SMZ–TMP and quinolones, especially the ciprofloxacin, are the major antibiotic used. This study also shows the emergence of clinical S. maltophilia strains which are not susceptible to SMZ–TMP and quinolones and this development may pose a more serious threat in the near future because treatment options may become depleted and limited despite the mortality rate of this specific group of ABM not being high at this time. © 2013 Elsevier B.V. All rights reserved. 1. Introduction Stenotrophomonas (S.) maltophilia, a Gram-negative, non- fermentative bacillus, has a wide distribution in both natural and man-made environment. Although it is an important pathogen of hospital-acquired infections, particularly in severely debilitated and immuno-suppressed patients [1–5], S. maltophilia is still an uncommon causative pathogen of adult bacterial meningitis (ABM) and only sporadic case studies have been reported [6–17]. Clini- cally, because of the intrinsic resistance mechanisms against most * Corresponding author at: Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City 833, Taiwan. Tel.: +886 7 7317123x2283; fax: +886 7 7333816. E-mail address: cwenneng@ms19.hinet.net (W.-N. Chang). 1 This author contributed equally to the first author. antimicrobial agents, clinical S. maltophilia strains can develop resistance during treatment [1,2,18,19]. At the same time, poorly standardized susceptibility tests and interpretation criteria, and difficulties in translating in vitro findings into clinical practice have made the management of S. maltophilia infection a therapeutic challenge [1,2,18,19]. In order to establish a better understanding of S. maltophilia-related ABM, this study analyzed the clinical and laboratory characteristics of this specific group of central nervous system (CNS) infection. 2. Methods The microbiology records for cerebro-spinal fluid (CSF) and medical records of ABM patients admitted to Chang Gung Memorial Hospital (CGMH)-Kaohsiung over a period of nine years (January 2001 to December 2009) were retrospectively reviewed. In the 0303-8467/$ – see front matter © 2013 Elsevier B.V. All rights reserved. http://dx.doi.org/10.1016/j.clineuro.2013.03.006