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.