Key Clinical Message:
Cefoperazone in combination with ciprofloxacin could be a potential
therapeutic alternative, to treat nosocomial Pseudomonas
aeoginosa meningitis, especially in countries with limited resources
where reference treatments are unavailable.
Background:
Nosocomial meningitis (NM) following spinal anaesthesia is a very rare
event, but it is a therapeutic emergency as it can affect the functional
prognosis and can be life-threatening in the short term.Pseudomonas aeruginosa is one of the non-fermenting Gram-negative
bacilli responsible for severe nosocomial infections including
nosocomial meningitis [1]. Its treatment remains a challenge in low
resource countries such as Madagascar. Ceftazidime or cefepime are the
recommended first-line treatments for Pseudomonas NM, but
none of these molecules are available in poor countries like Madagascar
[2] [3] [4]. Cefoperazone, recently introduced in Madagascar
in its combined form with sulbactam, is a third-generation
broad-spectrum cephalosporin that is little known in Europe and the
United States but is well known in Asian countries. We report the first
case of nosocomial meningitis after spinal anaesthesia caused byPseudomonas aeruginosa treated effectively with the combination
of cefoperazone and ciprofloxacin.