ADJUNCTIVE THERAPIES IN ACUTE BACTERIAL MENINGITIS Erich Schmutzhard Department of Neurology, NICU Medical University Innsbruck, Austria Conflict of Interest: research grants and/or speaker‘s honoraria received from: ZOLL, Pfizer, Bayer, Baxter, Sandoz, Phillips. Innercool, Novo-Nordisk, Actelion, Vasopharm, Edge, Ever
in addition …. easier availabilty of meningococcal vaccines (A, W 135) in Subsaharan Africa (WHO; Bill and Melinda Gates Foundation, 2010) or serogroup B vaccine in Europe rates of bacterial meningitis decrease and will further decrease…
KEYWORDS: bacterial meningitis antibiotic treatment delay PUBMED: accessed: 3 rd June 2016: 137 hits
Metaanalysis Europeans 55 years of age (pneumococci !!!)
EFNS Guideline for the use of PCR technology for the diagnosis of infections of the nervous system Israel Steiner, 1 Erich Schmutzhard, 2 Johann Sellner, 3 Abhijit Chaudhuri, 4 Peter G. E. Kennedy 5 1 Department of Neurology, Rabin Medical Center, Beilinson Campus, Petach Tikva, Israel, 2 Department of Neurology, NICU, Medical University Innsbruck, Austria, 3 Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Germany , 4 Clinical Neurosciences, Queen’s Hospital, Romford, UK and 5 Glasgow University, Department of Neurology, Institute of Neurological Sciences, Southern General Hospital, Glasgow, Scotland, UK Eur J Neurol, 2012. PCR technology is currently a reliable method for the diagnosis of viral and bacterial (except tuberculosis) infections, and for some protozoal infections and helminthic infestations of the CNS. Matthijs C. Brouwer, Guy E. Thwaites, Allan R. Tunkel, Diederik van de Beek (2012) Dilemmas in the diagnosis of bacterial meningitis. Lancet Clinical Seminar, Lancet, in press
Neurologic/neuro-intensive complications complication • Brain edema • Hydrocephalus • Arteriitis • Brain-infarct(s) • Sinus-/venous thrombosis • Cerebritis, Abscess modified acc. to Weber J, 2014 frequency ~ 15% ~ 10% ~ 5% < 5%
GENERAL RULE in intensive care medicine: Avoid by any means and in every patient HYPO- and HYPERGLYCEMIA!!!
Neuro-ICU Innsbruck
YES, SHOULD BE STRONGLY CONSIDERED fastest possible initiation but slow infusion rate
Neuro-ICU Innsbruck
Neuro-ICU Innsbruck
Neuro-ICU Innsbruck
NEUES BEI DER AKUTEN BAKTERIELLEN MENINGITIS Neuro-ICU Innsbruck
NEWS IN ACUTE BACTERIAL MENINGITIS Be ready to employ - with all precautions - also in acute bacterial meningitis: -neurocritical care medicine -general/systemic critical care medicine (e. g. for concomitant/accompanying sepsis syndrome) -all monitoring methods Nosocomial meningitis is different from community acquired meningitis and do not forget epidemiology and epidemiological trends Neuro-ICU Innsbruck
NEUES BEI DER AKUTEN BAKTERIELLEN MENINGITIS if and where available: (neuro-)critical care medicine Neuro-ICU Innsbruck
Neuro-ICU Innsbruck
Neuro-ICU Innsbruck
global published 02. 05. 2014 be updated Neuro-ICU Innsbruck
Antibiotic Resistance in Uganda: Recent Publications • • • • • • Ainembabazi P. The effect of Chlorhexidine gluconate on Gram-negative Multi-drug Resistant Bacteria that produce Extended Spectrum Beta Lactamases in Mulago Hospital. A Special Project Report submitted to the College of Veterinary Medicine, Animal Resources and Bio-Security, in partial Fulfillment of the Requirements for the award of a Bachelors Degree in Biomedical Laboratory Technology of Makerere University. 2014. Amito PF, Otim F, Okongo F, Ogwang M and Greco D. The prevalence and antibiotics susceptibility pattern of Neisseria gonorrhoeae in patients attending OPD clinics at St. Mary’s Hospital Lacor Uganda. J prev med hyg 2012: 53; 186 -189. Andabati G and Byamugisha J. Microbial aetiology and sensitivity of asymptomatic bacteriuria among ante-natal mothers in Mulago hospital, Uganda. Afr Health Sci 2010: 10(4); 349– 352. PMCID: PMC 3052809. Batwala V, Magnussen P and Nuwaha F. Antibiotic use among patients with febrile illness in a low malaria endemicity setting in Uganda. Malaria Journal 2011; 10: 377. Bazira J, Boum II Y, Sempa J, Iramiot J, Nanjebe D, Sewankambo N and Nakanjako D. Trends in Antimicrobial Resistance of Staphylococcus aureus Isolated from Clinical Samples at Mbarara Regional Referral Hospital in Rural Uganda. British Microbiology Research Journal 2014; 4(10): 1084 -1091. Byarugaba DK, Kisame R and Olet S. Multi-drug resistance in commensal bacteria of food of animal origin in Uganda. African Journal of Microbiology Research 2011; 5(12): 1539 -1548. Ikwap K, Erume J, Owiny DO, Nasinyama GW, Melin L, Björn Bengtsson B, Lundeheim N, Fellström C and Jacobson M. Salmonella species in piglets and weaners from Uganda: Prevalence, antimicrobial resistance and herd-level risk factors. Preventive Veterinary Medicine 2014; 115: 39– 47. Iramiot J, Stanley, Bwanga F, Itabangi H, Nakaye M, Mwambi B and Bazira J. Prevalence and Antibiotic Susceptibility Patterns of Clinical Isolates of Methicillin-Resistant Staphylococcus aureus in a Tertiary Care Hospital in Western Uganda. British Microbiology Research Journal 2014; 4(10): 1168 -1177. Kalule JB, Kaddu-Mulindwa DH and Asiimwe BB. Antimicrobial Drug Resistance and Plasmid Profiles of Salmonella Isolates from Humans and Foods of Animal Origin in Uganda. Advances in Infectious Diseases 2012; 2: 151 -155 Kamulegeya A, Buwembo W and Rwenyonyi CM. Knowledge and Antibiotics Prescription Pattern among Ugandan Oral Health Care Providers: A Cross-sectional Survey. Journal of Dental Research, Dental Clinics, Dental Prospects 2011; 5(2). Kateete DP, Namazzi S, Okee M, Okeng A, Baluku H, Musisi NL, Katabazi FA, Joloba ML, Ssentongo R and Najjuka FC. High Prevalence of Methicillin resistant Staphylococcus aureus in the surgical units of Mulago hospital in Kampala, Uganda. BMC Research Notes 2011; 4: 326. Kigozi E. Enterococci Species Occurrence and their Levels of Resistance to commonly used Drugs. A Special Project Report submitted to the College of Veterinary Medicine, Animal Resources and Bio-Security, in partial Fulfillment of the Requirements for the award of a Bachelors Degree in Biomedical Laboratory Technology of Makerere University: August, 2012. Kitara LD, Anywar AD, Acullu D, Odongo-Aginya E, Aloyo J and Fendu M. Antibiotic susceptibility of Staphylococcus aureus in suppurative lesions in Lacor Hospital, Uganda. African Health Sciences 2011; 11(S 1): S 34 - S 39. Knaapen J. An insight into antibiotic prescription practice at Mulago Hospital, Uganda. Report of Scientific Participation UM, academic year 2012/2013. Kampala, Uganda. Supervisors: Florence Najjuka, Astrid Oude Lash of Medicin Maastricht University In collaboration with Makerere University. Kyeyune P. Antibiotic Resistance Patterns of Escherichia coli isolated from fecal Matter of healthy broiler Chicken reared under dip liter System from selected Divisions of Kampala District. A Research Project Report submitted to Faculty of Veterinary Medicine in partial Fulfilment of the Requirements for the award of a Bachelors Degree in Biomedical Laboratory Technology of Makerere University. 2011. Mahero M, Byarugaba DK, Doetkott DK, Olet S and Khaitsa ML. Antimicrobial Resistance and Presence of Class 1 Integrons in Salmonella Serovars Isolated from Clinical Cases of Animals and Humans in North Dakota and Uganda. Clin Microbial 2013; 2: 6. Means AR, Weaver MC, Burnett SM, Mbonye MK, Naikoba S and Mc. Clelland RS. Correlates of Inappropriate Prescribing of Antibiotics to patients with Malaria in Uganda. PLo. S ONE 2014; 9(2). Mukonzo JK, Namuwenge PM, Okure G, Mwesige B, Namusisi OK and Mukanga D. Over-the-counter suboptimal dispensing of antibiotics in Uganda. Journal of Multidisciplinary Healthcare 2013; 6: 303 -310. Nambatya J, Nyairo S, Bironse M, Kachwiya S, Musigunzi N and Kamulegeya A. Antibiotic use, knowledge and behaviour at a Ugandan University. Int J Infect Control 2011; v 7: i 4. Ndidde Y, Akullo J, Zirintuda G and Ekou J Postmortem incidence and trends of New Castle Disease virus among chicken presented for diagnosis at Makerere University Central Veterinary Laboratory: A retrospective study. Journal of Veterinary Medicine and Animal Health 2014; 8: 217 -221. Ocan M, Bwanga F, Bbosa GS, Bagenda D and Waako P. Patterns and Predictors of Self-Medication in Northern Uganda PLo. S ONE 2014; 9(3). Seni J, Najjuka CF, Kateete DP, Makobore P, Joloba ML, Kajumbula H, Kapesa A and Bwanga F. Antimicrobial resistance in hospitalized surgical patients: a silently emerging public health concern in Uganda. BMC Research Notes 2013; 6: 298. Ssennoga A. Assessment of drug susceptibility patterns of methicillin resistant Staphylococcus aureus on archived samples within Mulago National Referral and Teaching Hospital. A special research project report submitted in partial fulfillment of the requirement for the award of the degree of Bachelor of Biomedical Laboratory Technology of Makerere University. 2014. Svanström PU. Pathogens and antibiotic resistant bacteria in abattoir waste and animals – a study involving abattoir wastewater, earthworms and Marabou storks. Degree
Antibiotic Resistance in Uganda: Recent Publications • • • • • • Ainembabazi P. The effect of Chlorhexidine gluconate on Gram-negative Multi-drug Resistant Bacteria that produce Extended Spectrum Beta Lactamases in Mulago Hospital. A Special Project Report submitted to the College of Veterinary Medicine, Animal Resources and Bio-Security, in partial Fulfillment of the Requirements for the award of a Bachelors Degree in Biomedical Laboratory Technology of Makerere University. 2014. Amito PF, Otim F, Okongo F, Ogwang M and Greco D. The prevalence and antibiotics susceptibility pattern of Neisseria gonorrhoeae in patients attending OPD clinics at St. Mary’s Hospital Lacor Uganda. J prev med hyg 2012: 53; 186 -189. Andabati G and Byamugisha J. Microbial aetiology and sensitivity of asymptomatic bacteriuria among ante-natal mothers in Mulago hospital, Uganda. Afr Health Sci 2010: 10(4); 349– 352. PMCID: PMC 3052809. Batwala V, Magnussen P and Nuwaha F. Antibiotic use among patients with febrile illness in a low malaria endemicity setting in Uganda. Malaria Journal 2011; 10: 377. Bazira J, Boum II Y, Sempa J, Iramiot J, Nanjebe D, Sewankambo N and Nakanjako D. Trends in Antimicrobial Resistance of Staphylococcus aureus Isolated from Clinical Samples at Mbarara Regional Referral Hospital in Rural Uganda. British Microbiology Research Journal 2014; 4(10): 1084 -1091. Byarugaba DK, Kisame R and Olet S. Multi-drug resistance in commensal bacteria of food of animal origin in Uganda. African Journal of Microbiology Research 2011; 5(12): 1539 -1548. Ikwap K, Erume J, Owiny DO, Nasinyama GW, Melin L, Björn Bengtsson B, Lundeheim N, Fellström C and Jacobson M. Salmonella species in piglets and weaners from Uganda: Prevalence, antimicrobial resistance and herd-level risk factors. Preventive Veterinary Medicine 2014; 115: 39– 47. Iramiot J, Stanley, Bwanga F, Itabangi H, Nakaye M, Mwambi B and Bazira J. Prevalence and Antibiotic Susceptibility Patterns of Clinical Isolates of Methicillin-Resistant Staphylococcus aureus in a Tertiary Care Hospital in Western Uganda. British Microbiology Research Journal 2014; 4(10): 1168 -1177. Kalule JB, Kaddu-Mulindwa DH and Asiimwe BB. Antimicrobial Drug Resistance and Plasmid Profiles of Salmonella Isolates from Humans and Foods of Animal Origin in Uganda. Advances in Infectious Diseases 2012; 2: 151 -155 Kamulegeya A, Buwembo W and Rwenyonyi CM. Knowledge and Antibiotics Prescription Pattern among Ugandan Oral Health Care Providers: A Cross-sectional Survey. Journal of Dental Research, Dental Clinics, Dental Prospects 2011; 5(2). Kateete DP, Namazzi S, Okee M, Okeng A, Baluku H, Musisi NL, Katabazi FA, Joloba ML, Ssentongo R and Najjuka FC. High Prevalence of Methicillin resistant Staphylococcus aureus in the surgical units of Mulago hospital in Kampala, Uganda. BMC Research Notes 2011; 4: 326. Kigozi E. Enterococci Species Occurrence and their Levels of Resistance to commonly used Drugs. A Special Project Report submitted to the College of Veterinary Medicine, Animal Resources and Bio-Security, in partial Fulfillment of the Requirements for the award of a Bachelors Degree in Biomedical Laboratory Technology of Makerere University: August, 2012. Kitara LD, Anywar AD, Acullu D, Odongo-Aginya E, Aloyo J and Fendu M. Antibiotic susceptibility of Staphylococcus aureus in suppurative lesions in Lacor Hospital, Uganda. African Health Sciences 2011; 11(S 1): S 34 - S 39. Knaapen J. An insight into antibiotic prescription practice at Mulago Hospital, Uganda. Report of Scientific Participation UM, academic year 2012/2013. Kampala, Uganda. Supervisors: Florence Najjuka, Astrid Oude Lash of Medicin Maastricht University In collaboration with Makerere University. Kyeyune P. Antibiotic Resistance Patterns of Escherichia coli isolated from fecal Matter of healthy broiler Chicken reared under dip liter System from selected Divisions of Kampala District. A Research Project Report submitted to Faculty of Veterinary Medicine in partial Fulfilment of the Requirements for the award of a Bachelors Degree in Biomedical Laboratory Technology of Makerere University. 2011. Mahero M, Byarugaba DK, Doetkott DK, Olet S and Khaitsa ML. Antimicrobial Resistance and Presence of Class 1 Integrons in Salmonella Serovars Isolated from Clinical Cases of Animals and Humans in North Dakota and Uganda. Clin Microbial 2013; 2: 6. Means AR, Weaver MC, Burnett SM, Mbonye MK, Naikoba S and Mc. Clelland RS. Correlates of Inappropriate Prescribing of Antibiotics to patients with Malaria in Uganda. PLo. S ONE 2014; 9(2). Mukonzo JK, Namuwenge PM, Okure G, Mwesige B, Namusisi OK and Mukanga D. Over-the-counter suboptimal dispensing of antibiotics in Uganda. Journal of Multidisciplinary Healthcare 2013; 6: 303 -310. Nambatya J, Nyairo S, Bironse M, Kachwiya S, Musigunzi N and Kamulegeya A. Antibiotic use, knowledge and behaviour at a Ugandan University. Int J Infect Control 2011; v 7: i 4. Ndidde Y, Akullo J, Zirintuda G and Ekou J Postmortem incidence and trends of New Castle Disease virus among chicken presented for diagnosis at Makerere University Central Veterinary Laboratory: A retrospective study. Journal of Veterinary Medicine and Animal Health 2014; 8: 217 -221. Ocan M, Bwanga F, Bbosa GS, Bagenda D and Waako P. Patterns and Predictors of Self-Medication in Northern Uganda PLo. S ONE 2014; 9(3). Seni J, Najjuka CF, Kateete DP, Makobore P, Joloba ML, Kajumbula H, Kapesa A and Bwanga F. Antimicrobial resistance in hospitalized surgical patients: a silently emerging public health concern in Uganda. BMC Research Notes 2013; 6: 298. Ssennoga A. Assessment of drug susceptibility patterns of methicillin resistant Staphylococcus aureus on archived samples within Mulago National Referral and Teaching Hospital. A special research project report submitted in partial fulfillment of the requirement for the award of the degree of Bachelor of Biomedical Laboratory Technology of Makerere University. 2014. Svanström PU. Pathogens and antibiotic resistant bacteria in abattoir waste and animals – a study involving abattoir wastewater, earthworms and Marabou storks. Degree CDDEP (Center for Disease Dynamics, Economics and Policy, Washington DC, New Delhi 2015
Brazil, Russia, India, China and South Africa = BRICS CDDEP (Center for Disease Dynamics, Economics and Policy, Washington DC, New Delhi 2015)
World map of antibiotic resistance, CDDEP, 2015
Courtesy: Catherine Storey THANK YOU FOR YOUR ATTENTION
in addition …. easier availabilty of meningococcal vaccines (A, W 135) in Subsaharan Africa (WHO, Bill and Melinda Gates Foundation, 2014) or serogroup B vaccine in Europe rates of bacterial meningitis decrease and will further decrease…
Change in epidemiology * AGE * PATHOGENIC AGENTS HOSPITAL ACQUIRED INFECTIONS in addition …. easier availabilty of meningococcal vaccines (A, W 135) in Subsaharan Africa (WHO; Bill and Melinda Gates Foundation, 2014) or serogroup B vaccine in Europe rates of bacterial meningitis decrease and will further decrease…
HOSPITAL ACQUIRED INFECTIONS MRSA Gram-negatives (e. g. Enterobacteriaceae, Pseudomonas spp) in addition …. easier availabilty of meningococcal vaccines (A, W 135) in Subsaharan Africa (WHO, Bill and Melinda Gates Foundation, 2014) or serogroup B vaccine in Europe rates of bacterial meningitis decrease and will further decrease…
Metaanalysis Europeans 55 years of age (gram negatives ? ? )
This means: Incidence of community-acquired bacterial meningitis will further decrease, and, with this, also the „level of awareness“ è In these – then – „single cases“: Emergency care, intensive care neurology and neuro -critical care will be even more important
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