To investigate the conditions that have developed in the treatment of posttraumatic
meningitis with the use of new
antibiotics, the authors studied cases with this
infection retrospectively for a period of 68 months. Among 860 patients with moderate to severe
head injuries, 12 (1.39%) sustained this complication. Of these, nine patients (75%) had a demonstrable
basilar skull fracture and seven (58.3%) presented obvious
rhinorrhea. Of these seven, four (57.1%) were treated conservatively and three (42.8%) finally underwent surgery for dural repair. The infecting agents were Gram-positive cocci (Staphylococcus haemolyticus, Staphylococcus warneri, Staphylococcus cohnii, Staphylococcus epidermidis, and Streptococcus pneumoniae) in five patients and Gram-negative bacilli in six patients (Escherichia coli in two, Klebsiella pneumoniae in two, and Acinetobacter anitratus in two). In one patient, the culture results were negative. All Gram-negative strains appeared resistant to
ampicillin and
third-generation cephalosporins, but sensitive to
imipenem and to the
quinolone ciprofloxacin. Gram-positive strains were sensitive to
vancomycin.
Hydrocephalus finally developed in the two patients who had received intrathecal infusions of
amikacin. No other report of the relation of intrathecal infusion of
antibiotics and the development of
hydrocephalus was found. All patients survived, indicating that, for the present, posttraumatic
meningitis is a nonfatal complication of
head injury.