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Hospital-acquired meningitis in patients undergoing craniotomy: incidence, evolution, and risk factors
Magaly Cecília Franchini Reichert1, Eduardo Alexandrino Servolo Medeiros, Fernando Antonio Patriani Ferraz
1Federal University of São Paulo, Escola Paulista de Medicina, Brazil.
Objectives:
To establish the incidence of postcraniotomy meningitis, identify etiologic agents, assess patients' medical progress in relation to both length of hospitalization and mortality, and analyze risk factors.
Material And Methods:
This study was developed at Hospital São Paulo, a tertiary university hospital, between August 1995 and January 1998. We conducted a case-control trial, in which 50 pairs of patients were matched.
Results:
An 8.9%-postcraniotomy meningitis incidence was found. Gram-negative bacilli were the most common etiologic agents isolated. Mortality among the patients was 30%. Mean hospital stay for the patients was 42.9 +/- 22.1 days; for the controls, mean hospital stay was 19.0 +/- 11.4 days (P =.00001). Although several risk factors were identified by univariate analysis, including postoperative external ventricular shunt (OR = 2.92, CI 95% = 1.245-6.865, P =.014), remote site infection (OR = 2.85, CI 95% = 0.995-8.173, P =.051), and repeat operation (OR = 5.02, CI 95% = 1.569-16.066, P =.007), only repeat operation remained in the multivariate analysis model (OR = 3.68, CI 95% = 1.158-11.700, P =.027).
Conclusion:
Postcraniotomy meningitis resulted in a high mortality rate and a longer hospital stay, with repeat operation identified among the risk factors.
Insights
Postcraniotomy meningitis occurs in 8.9% of cases, leading to high mortality and prolonged hospital stays. Repeat operations are a significant risk factor for developing this infection.
Area of Science:
- Neurosurgery
- Infectious Diseases
- Epidemiology
Background:
- Postcraniotomy meningitis is a serious complication following brain surgery.
- Understanding its incidence, causes, and risk factors is crucial for patient outcomes.
Purpose of the Study:
- To determine the incidence of postcraniotomy meningitis.
- To identify causative agents and analyze associated risk factors.
- To assess the impact on patient hospitalization and mortality.
Main Methods:
- A case-control study was conducted at a tertiary university hospital.
- 50 pairs of patients were matched for the study.
- Data were collected between August 1995 and January 1998.
Main Results:
- The incidence of postcraniotomy meningitis was 8.9%.
- Gram-negative bacilli were the predominant etiologic agents.
- Mortality was 30%, with a mean hospital stay of 42.9 days for meningitis patients versus 19.0 days for controls.
- Repeat operation was a significant risk factor (OR = 3.68).
Conclusions:
- Postcraniotomy meningitis significantly increases mortality and hospital stay duration.
- Repeat operations are identified as a key risk factor.
- Effective preventative strategies are needed to mitigate these risks.