OBJECTIVES: Bacterial and aseptic meningitis after neurosurgery can present similar clinical signs and symptoms. The aims of this study were to develop and test a molecular method to diagnose bacterial meningitis (BM) after neurosurgery. METHODS: A 16S ribosomal RNA gene PCR-based strategy was developed using artificially inoculated cerebrospinal fluid (CSF) followed by sequencing. The method was tested using CSF samples from 43 patients who had undergone neurosurgery and were suspected to suffer from meningitis, and from 8 patients without neurosurgery or meningitis. Patients were classified into five groups, confirmed BM, probable BM, possible BM, unlikely BM, and no meningitis. RESULTS: Among the samples from the 51 patients, 21 samples (41%) were culture-negative and PCR-positive. Of these, 3 (14%) were probable BM, 4 (19%) were possible BM, 13 (62%) were unlikely BM, and 1 (5%) was meningitis negative. Enterobacterales, non-fermenters (Pseudomonas aeruginosa and Acinetobacter baumannii), Staphylococcus haemolyticus, Granulicatella, Variovorax, and Enterococcus cecorum could be identified. In the group of patients with meningitis, a good agreement (3 of 4) was observed with the results of cultures, including the identification of species. CONCLUSION: Molecular methods may complement the diagnosis, guide treatment, and identify non-cultivable microorganisms. We suggest the association of methods for suspected cases of BM after neurosurgery, especially for instances in which the culture is negative.

Seguindo uma tendência mundial, no Brasil, infecções por cepas de Acinetobacter baumannii multirresistentes (MRs) produtoras de carbapenemases do tipo oxacilinases (OXA) classe D de Ambler são atualmente consideradas uma emergência clínica e epidemiológica. Cepas de A. baumannii produtoras de OXA têm sido reportadas nos estados de Alagoas, Amazonas, Bahia, Distrito Federal, Espírito Santo, Goiás, Mato Grosso, Mato Grosso do Sul, Minas Gerais, Paraná, Pernambuco, Rio de Janeiro, Rio Grande do Norte, Rio Grande do Sul, Santa Catarina e São Paulo. Em algumas unidades, a presença de A. baumannii produtor de OXA-23 e/ou OXA-143 (até agora restrita ao Brasil) tem adquirido um caráter de endemicidade, sendo as cepas de A. baumannii carregando genes blaOXA-23 identificadas em efluentes hospitalares, constituindo um risco potencial para a comunidade e o meio ambiente. Embora, a tipagem molecular por multilocus sequence typing (MLST) (esquema proposto por Bartual, Universidade de Oxford, http://pubmlst.org/abaumannii/) tem caracterizado a disseminação internacional de um complexo clonal (CC) denominado CC92, no Brasil, a maioria das cepas produtoras de OXA-23 pertencem ao complexo clonal CC113, CC109 ou CC104. Finalmente, do ponto de vista clínico, o principal problema das infecções por A. baumannii é o uso limitado de antibacterianos com atividade in vitro, muitas vezes restrito ao uso de ampicilina/sulbactam, polimixina B e/ou colistina (polimixina E).

Following a worldwide trend, infections caused by MDR OXA-type (Ambler class D) carbapenemase-producing Acinetobacter baumannii are currently regarded as a clinical and epidemiological emergency in Brazil. OXA-producing A. baumannii strains have been identified in the states of Alagoas, Amazonas, Bahia, Distrito Federal, Espírito Santo, Goiás, Mato Grosso, Mato Grosso do Sul, Minas Gerais, Paraná, Pernambuco, Rio de Janeiro, Rio Grande do Norte, Rio Grande do Sul, Santa Catarina and São Paulo. In some settings, the presence of OXA-23- and/or OXA-143 -producing A. baumannii (so far restricted to Brazil) has been endemic and A. baumannii strains carrying blaOXA-23 genes have been detected in hospital wastewater effluents, hence a potential risk to the community and the environment. Although molecular typing by multilocus sequence typing (MLST - Bartual scheme, University of Oxford, http://pubmlst.org/abaumannii/) has revealed the international spread of a clonal complex (CC) denominated CC92, in Brazil most OXA-23-producing A. baumannii belong to CC113, CC109 or CC104 clonal complexes. Finally, from a clinical point of view, the main problem of A. baumannii infections is the limited use of antibacterial agents with in vitro activity, often restricted to ampicillin/sulbactam, polymyxin B and/or colistin (polymyxin E).