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Risk factors associated with postcraniotomy meningitis: A retrospective study
Chang-Hua Chen1, Chih-Yen Chang, Li-Jhen Lin
1Division of Infectious Disease, Department of Internal Medicine Infection Control Committee Department of Medical Imaging Epidemiology and Biostatistics Center Department of Neurosurgery Division of Critical Care Medicine Changhua Christian Hospital, Changhua Department of Nursing, College of Medicine and Nursing, Hung Kuang University, Taichung County, Taiwan.
Abstract:
Postcraniotomy meningitis (PCM) is a major challenge in neurosurgery, and changing patterns of infectious agents in PCM have been noted. The limited epidemiological data and urgent clinical needs motivated this research. We conducted this study to determine a risk assessment for PCM and the current pattern of infectious agents.We performed a retrospective case-control study of significant cases of postcraniotomy meningitis in the Changhua Christian Hospital System between January 1, 2008, and December 31, 2012. Postcraniotomy meningitis was diagnosed in 22 out of 4392 surgical patients; this data was reviewed for risk assessment.This study assessed the risk factors for postcraniotomy meningitis and found that it was more frequently seen in patients who were elderly (OR = 1.57, 95% CI = 1.32-2.98, P = 0.013), underwent emergency procedures (OR = 4.82, 95% CI = 1.50-14.53, P = 0.008), had leak of cerebrospinal fluid (OR = 4.62, 95% CI = 2.03-10.50, P = 0.012), had external ventricular drainage (OR = 4.68, 95% CI = 2.46-8.87, P = 0.006), were admitted to the intensive care unit (OR = 2.41, 95% CI = 1.53-8.08, P = 0.012), had used drain placement >72 hours (OR = 2.66, 95% CI = 1.04-4.29, P = 0.007), had surgery >4.5 hours (OR = 2.38, 95% CI = 1.39-4.05, P = 0.005), had repeat operations (OR = 2.74, 95% CI = 1.31-5.73, P = 0.018), endured trauma (OR = 5.97, 95% CI = 1.57-17.61, P = 0.007), or had 30-days mortality (OR = 5.07, 95% CI = 2.20-11.48, P = 0.001). The predominant pathogens isolated from cerebrospinal fluid were Staphylococcus aureus in 8 patients (36.7%) and Acinetobacter baumannii in 7 patients (31.8%). In our study, the mortality rate was 5.1% among all postcraniotomy patients.Accurate risk assessment, early diagnosis, and choice of appropriate antibiotics in accordance with epidemiologic information are the cornerstones of reducing mortality and morbidity in PCM. The changing pattern of infectious agents in PCM over time suggests the necessity of further studies to provide the most up-to-date insight to physicians.
Insights
Postcraniotomy meningitis (PCM) risk factors include elderly patients, emergency surgery, and cerebrospinal fluid leaks. Staphylococcus aureus and Acinetobacter baumannii were the most common pathogens, highlighting the need for updated treatment strategies.
Area of Science:
- Neurosurgery
- Infectious Diseases
- Epidemiology
Background:
- Postcraniotomy meningitis (PCM) is a significant complication in neurosurgery.
- Changing patterns of infectious agents in PCM necessitate updated epidemiological data and risk assessments.
Purpose of the Study:
- To determine risk factors for PCM.
- To identify the current pattern of infectious agents causing PCM.
Main Methods:
- Retrospective case-control study conducted between January 1, 2008, and December 31, 2012.
- Reviewed 22 cases of PCM out of 4392 postcraniotomy patients.
- Assessed risk factors and identified causative pathogens from cerebrospinal fluid samples.
Main Results:
- Identified elderly patients, emergency procedures, cerebrospinal fluid leaks, external ventricular drainage, ICU admission, prolonged drain placement (>72 hours), extended surgery duration (>4.5 hours), repeat operations, trauma, and 30-day mortality as significant risk factors.
- Staphylococcus aureus (36.7%) and Acinetobacter baumannii (31.8%) were the predominant pathogens.
- Overall mortality rate for postcraniotomy patients was 5.1%.
Conclusions:
- Accurate risk assessment, early diagnosis, and appropriate antibiotic selection based on current epidemiology are crucial for reducing PCM mortality and morbidity.
- The evolving patterns of infectious agents underscore the need for ongoing research to guide clinical practice.
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