Post-neurosurgical nosocomial bacterial meningitis in adults: microbiology, clinical features, and outcomes

doi:10.1016/j.jocn.2004.09.017

Journal of Clinical Neuroscience

Volume 12, Issue 6, August 2005, Pages 647-650

https://doi.org/10.1016/j.jocn.2004.09.017 Get rights and content

Summary

The clinical data of 62 adult patients who suffered post-neurosurgical nosocomial bacterial meningitis, retrospectively collected over a 16-year period, were studied. Cases were divided into two groups based on the date of presentation, the first period being 1986–1993 and the second 1994–2001. Fever and progressive consciousness disturbance were the most consistent clinical features - signs that may also be attributed to other postoperative neurosurgical problems. The common pathogens included Staphylococcus aureus, coagulase negative Staphylococcus, Pseudomonas aeruginosa, Escherichia coli, and Acinetobacter baumannii. An increase in polymicrobial infections and multi-antibiotic resistance during the second period was identified. In the first half of the study, mortality was 22%, and in the second half 36%. Adult post-neurosurgical nosocomial bacterial meningitis has become an important clinical problem. The choice of appropriate empirical antibiotics is challenging and must be guided by an awareness of the relative frequency of various pathogens and the increasing incidence of resistant strains. Although high mortality rates may, in part, be related to the primary brain pathology, early diagnosis and the timely use of antibiotics based on antimicrobial susceptibility testing are essential for survival.

Introduction

Bacterial meningitis after neurosurgical procedures is still relatively uncommon but the incidence may be increasing. Procedures most commonly responsible for post-neurosurgical meningitis include craniotomy, ventriculostomy, ventriculoperitoneal shunt insertion, epidural anesthesia and lumbar puncture.¹ Although prophylactic antibiotic therapy is generally used prior to neurosurgical procedures, its effectiveness has been debated.[2], [3] The widespread use of antibiotics for upper respiratory tract infections and the increasing frequency of neurosurgical procedures may have changed the epidemiology and clinical spectrum of post-neurosurgical meningitis in recent years.[4], [5], [6], [7], [8], [9], [10]

Over a 16-year period, 62 patients with post-neurosurgical nosocomial bacterial meningitis were treated at the Chang Gung Memorial Hospital, Kaohsiung. This study aimed to examine (1) the causative pathogens; (2) the clinical features relevant to meningitis; (3) association with underlying conditions; and (4) the outcomes of therapy for these patients.

Section snippets

Patients and methods

A retrospective review of medical records using previously designed standardized evaluation forms was undertaken for patients admitted to Chang Gung Memorial Hospital, Kaohsiung between January 1986 and December 2001 in whom a diagnosis of bacterial meningitis was made after a neurosurgical procedure. The CSF and blood culture microbiology results of these patients were also reviewed. Chang Gung Memorial Hospital, Kaohsiung is a 2482-bed acute-care teaching hospital, which provides both primary

Results

The 62 patients with post-neurosurgical nosocomial bacterial meningitis comprised 43 males (mean age 46; range 17 to 80) and 19 females (mean age 55; range 18 to 78). The percentage of post-neurosurgical nosocomial meningitis in all culture-proven adult bacterial meningitis in the first and second halves of the study period were 12% (9/73) and 27% (53/194), respectively. In this study, the infection rate was 0.28% (35/12980) after craniotomy, and 1.2% (27/2220) after ventriculostomy or

Discussion

The exact incidence of bacterial meningitis after neurosurgical procedures and head trauma is unknown, but reported incidences vary from 0.0007% to 14.8%.[4], [6] This study showed an increase in the percentage of adult post-neurological nosocomial meningitis compared to all adult bacterial meningitis from 9/73 (12.33%) in the first half of the study to 53/194 (27.32%) in the second half. The infection rate was 0.28% (35/12980) after craniotomy, and 1.2% (27/2220) after ventriculostomy or

Conclusion

Adult post-neurosurgical nosocomial meningitis has become an important subgroup of bacterial meningitis presenting in the hospital setting. The diagnosis may be difficult due to the poor specificity of clinical and laboratory signs. The emergence of multi-antibiotic resistant strains and polymicrobial infections in recent years complicates therapy, and despite the introduction of newer antibiotics for the treatment of bacterial meningitis, fatality rates appear to have increased in this special

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Central nervous system infections in cancer patients
2022, Neurological Complications of Systemic Cancer and Antineoplastic Therapy
Central nervous system (CNS) infections remain a source of significant morbidity and mortality among cancer patients, despite the evolution of effective prophylactic regimens and better antimicrobials for active infection. With the past two decades’ introduction of more intensive immunosuppressive regimens, including solid organ and hematopoietic cell transplantation, and novel biologic response modifiers, as well as refinement of hematopoietic growth factor support of chemotherapy, longer survival has been achieved along with a change in the spectrum of infections in increasing types of vulnerable populations. For example, since the 1980s, the numbers of patients at risk for CNS infection after nontransplant hematologic malignancy treatment have almost reached the levels encountered in recipients of hematopoietic stem cell transplantation (HSCT), and nosocomial invasive fungal disease has doubled, while better control of bacteria and viruses has reduced the incidence of infections from these organisms. Rapid diagnosis is essential if patients are to experience meaningful survival without serious neurologic sequelae, a problem in at least one-third of long-term pediatric cancer survivors of CNS infections.
Postoperative antibiotic management strategy for febrile patient with posterior cranial fossa tumor resection: Retrospective clinical study
2020, Journal of Clinical Neuroscience
Postoperative fever (POF), associated with posterior cranial fossa (PCF) surgery, occurs commonly and is a potential intracranial infection indicator of perioperative antibiotics prolongation and advancement. The existing prophylactic approaches to balancing the risk between intracranial infection and antibiotics abuse are debatable.
We retrospectively assessed 100 patients subjected to PCF tumor resection between December 2015 and December 2018 at a single institution. Forty febrile patients were selected for further analysis. Of them, 16 received basic and 24 advanced antibiotics and were subjected to prophylactic antibiotic assessment.
The total POF rate of PCF tumor resection was 49.4%. POF occurred from day 1 to day 5, along with the abnormalities of cerebrospinal fluid (CSF) profiles and the mild meningeal irritation symptom. CSF cultures of all selected patients were negative. In the comparison between the basic and advanced antibiotic therapy, we found no statistically significant differences in the results of the average and dynamic analysis of the body temperature and CSF profiles. Negative results of outcome studies were also obtained in the duration of fever, duration of hospitalization, and total hospitalization expenses. However, the expenses were substantially increased in the advanced antibiotic treatment.
Although POF is a common symptom after PCF tumor resection, definite intracranial infection is rare. A high body temperature and significant abnormal CSF profiles at an early stage may not be a specific and sufficient indicator of intracranial infection to upgrade antibiotics therapy when standard prophylactic protocols have been accurately achieved.
Impact of an educational program on reducing health care–associated meningitis or ventriculitis in the neurosurgical intensive care unit
2020, American Journal of Infection Control
Health care–associated meningitis or ventriculitis (HCAMV) is a serious complication in different neurosurgical procedures and is associated with significant morbidity and mortality. We aimed to investigate whether an educational intervention program could reduce the HCAMV incidence in patients undergoing postsurgery external ventricular drainage and wound management.
We enrolled 2,904 patients from the neurosurgery intensive care unit between January 1, 2016 and December 31, 2018. The medical staff undertook an educational program developed by a multidisciplinary team on correct external ventricular drainage insertion and maintenance. The program included a 9-page self-learning module on the HCAMV risk factors and operational improvements. Each participant completed a pre- and posttest on their HCAMV knowledge.
We found that 38 of 693 (5.48%) patients presented with infection in the preintervention 9-month period. In the 27-month postintervention period, the proportion of HCAMV incidence dropped by 52.19% (P < .0001) to 58 of 2,211 (2.62%) patients.
Educational intervention aimed at the neurosurgery intensive care unit staff could significantly reduce the HCAMV rate, leading to a significant decline in the cost, morbidity, and mortality caused by neurosurgical procedures.
Community-acquired meningitis in adults caused by Escherichia coli in Denmark and The Netherlands
2018, Journal of Infection
We aimed to examine risk factors, presenting characteristics and complications of Escherichia coli community-acquired bacterial meningitis in adults.
Observational cohort study of adults > 16 years of age with cerebrospinal fluid culture-positive E. coli meningitis in Denmark and the Netherlands. Exclusion criteria were primary brain abscess, previous neurosurgery and nosocomial infections. We analysed baseline characteristics, concomitant infections and neurological complications. Outcome was assessed using the Glasgow Outcome Scale score (GOS) at discharge with GOS 1–4 categorised as unfavourable outcome.
We identified 36 patients with a median age of 69 years (interquartile range 61–83) of whom 15 (42%) were females. Immuno-compromise was present in 11 (31%) patients. Nineteen (53%) patients had concomitant infections consisting of urinary tract infections in 13 (36%), pneumonia in three (9%) and septic arthritis in two (6%). Bacteraemia with E. coli was found in 26 of 34 (76%) patients. Thirteen patients died (36%) and unfavourable outcome at discharge occurred in 23 (64%). Deaths were attributed to systemic complications in 12 (92%) patients.
Community-acquired E. coli meningitis in adults is a severe disease that primarily occurs in elderly patients with concomitant infections and an immunocompromised state. Outcome is often poor and mainly caused by systemic complications.
Prognostic Impact of Health Care–Associated Meningitis in Adults with Intracranial Hemorrhage
2017, World Neurosurgery
Citation Excerpt :
The clinical presentation of HCAMV after neurosurgical intervention can be indolent in nature.19 Although previous studies have reported fever and leukocytosis as indicative of nosocomial meningitis,20 we found no significant difference between the cases and controls (P > 0.1). However, we did see significant differences in hypoglycorrhachia, CSF pleocytosis, and elevated CSF lactate levels (P < 0.05) between patients with meningitis and patients without meningitis.
Health care–associated meningitis and ventriculitis (HCAMV) occurs in adults with intracranial hemorrhage (ICH) and is associated with high rates of morbidity and mortality, but the prognostic impact of this infectious complication in a controlled matched study of ICH is unknown.
We conducted a case-control study of adult patients with ICH and HCAMV at a large tertiary care hospital in Houston, Texas, from 2003 to 2016. Cases were defined as patients with ICH and HCAMV as documented by a positive cerebrospinal fluid culture. Controls were defined as patients with ICH without evidence of HCAMV. An adverse clinical outcome was defined as a Glasgow Outcome Scale score of ≤4.
This study included 120 patients with ICH; 40 patients also had HCAMV, whereas 80 patients had ICH with no evidence of HCAMV. Cases and controls were appropriately matched by age, Glasgow Coma Scale score, and Acute Physiology and Chronic Health Evaluation II score (P > 0.05). Patients with ICH and meningitis had more comorbidities, higher rates of abnormal neurologic examination, hypoglycorrhachia, and elevated cerebrospinal fluid lactate levels (P < 0.05). Adverse clinical outcomes were greater in patients with HCAMV and ICH than in patients with ICH alone (83% vs. 30%; P < 0.001). On logistic regression analysis, independent risk factors associated with an adverse outcome were HCAMV and mechanical ventilation (P < 0.05).
HCAMV has a significant prognostic impact in adults with ICH.
Clinical characteristics and antimicrobial therapy of healthcare-associated carbapenem-non-susceptible gram-negative bacterial meningitis: a 16-year retrospective cohort study
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Journal of Clinical Neuroscience

Summary

Introduction

Section snippets

Patients and methods

Results

Discussion

Conclusion

References (23)

Complications of head injury and their therapy

Neurosurg Clin N Am

MRSA meningitis and intrathecal injection of arbekacin

Surg Neurol

The prognostic factors of adult Gram-negative bacillary meningitis

J Hosp Infect

Rapid dissemination of Staphylococcus aureus with classic oxacillin resistance phenotype at a new university hospital

J Hosp Infect

Increasing nosocomial infections of methicillin-resistant Staphylococcus aureus at a teaching hospital in Taiwan

Int J Antimicrob Agents

Treatment of Staphylococcus epidermidis ventriculo-peritoneal shunt infection with linezolid

J Infect

Iatrogenic and traumatic-meningeal infections (french)

Rev Prat

Antibiotic prophylaxis in unrepaired CSF fistula

Br J Neurosurg

Posttraumatic meningitis:Bacteriology, hydrocephalus, and outcome

Neurosurgery

Comparative activity of imipenem, ceftazidime and cefotaxime against Acinetobacter calcoaceticus

J Antimicrob Chemother

Hospital-acquired bacterial meningitis in neurosurgical patients

J Neurosurg

Cited by (82)

Central nervous system infections in cancer patients

Postoperative antibiotic management strategy for febrile patient with posterior cranial fossa tumor resection: Retrospective clinical study

Impact of an educational program on reducing health care–associated meningitis or ventriculitis in the neurosurgical intensive care unit

Community-acquired meningitis in adults caused by Escherichia coli in Denmark and The Netherlands

Prognostic Impact of Health Care–Associated Meningitis in Adults with Intracranial Hemorrhage

Clinical characteristics and antimicrobial therapy of healthcare-associated carbapenem-non-susceptible gram-negative bacterial meningitis: a 16-year retrospective cohort study

Clinical studyPost-neurosurgical nosocomial bacterial meningitis in adults: microbiology, clinical features, and outcomes

Summary

Introduction

Section snippets

Patients and methods

Results

Discussion

Conclusion

Neurosurg Clin N Am

Surg Neurol

J Hosp Infect

J Hosp Infect

Int J Antimicrob Agents

J Infect

Iatrogenic and traumatic-meningeal infections (french)

Rev Prat

Antibiotic prophylaxis in unrepaired CSF fistula

Br J Neurosurg

Posttraumatic meningitis:Bacteriology, hydrocephalus, and outcome

Neurosurgery

Comparative activity of imipenem, ceftazidime and cefotaxime against Acinetobacter calcoaceticus

J Antimicrob Chemother

Hospital-acquired bacterial meningitis in neurosurgical patients

J Neurosurg

Clinical study
Post-neurosurgical nosocomial bacterial meningitis in adults: microbiology, clinical features, and outcomes