Management of Healthcare-associated Infection (HAI) Cases with Neuromeningeal Involvement in Decentralized Areas in Senegal

Abstract

Introduction: Healthcare-associated infections (HAIs) with neurological involvement are rare but constitute an absolute medical emergency. Early diagnosis and the initiation of appropriate antibiotic therapy are major challenges in their management. We report the results of an investigation into 4 cases of postoperative nosocomial meningoencephalitis in a rural area. Methodology: This is a descriptive observational study involving any patient residing in the study area and treated for nosocomial meningoencephalitis. The exposure factors included recent hospitalization, recent surgery, and obstetric care. The collected data (case notification forms, patient records, and IPC assessment tools) were analyzed using MS Excel® and/or Epi-Info®. Results: A total of 69 patients underwent surgical procedures. Four patients who had undergone a low transverse cesarean section developed meningoencephalitis. They were aged 25, 27, 39, and 40 years. One patient was asthmatic and had hypertension. The average incubation period was 12.25 days [2-20 days]. All four patients presented with meningeal syndrome and impaired consciousness. Seizures and motor deficits were observed in two patients. Cerebrospinal fluid (CSF) analysis suggested a bacterial infection, but no specific pathogen was isolated. However, environmental samples from the direct care area revealed the presence of methicillin-resistant Staphylococcus aureus (MRSA), Klebsiella pneumoniae subspecies, and non-carbapenemase-producing Pseudomonas. Despite early empiric antibiotic therapy and symptomatic treatment, 3 patients died. Therapeutic adjustment based on the antibiogram led to the recovery of one patient. All four infants are alive and in good health. Conclusion: We reported four cases of healthcare-associated infections (HAIs) in patients exposed to the same risk factors (low transverse cesarean section in the same operating room, using the same products and anesthetic practices) in a context of non-compliance with infection prevention and control (IPC) measures.