[Drainage-associated meningitis in neurocritical care patients. The results of a five-year prospective study]

to determine the incidence rate and risk factors for drainage-associated meningitis in neurocritical care patients.

The prospective study included 539 patients who spent more than 48 h at the Department of Neurocritical Care and underwent external ventricular drainage. The incidence rate and risk factors for drainage-associated meningitis were evaluated.

Over a 5-year period, 2140 patients have been hospitalized to the Department of Critical and Intensive Care (DCIC) for more than 48 h; of these, 539 patients underwent external ventricular drainage (EVD). Drainage-associated meningitis developed in 99 patients, which amounted to 19.8 (CI 16.3-23.3) per 100 patients with drainage and 18.3 (CI 14.3-22.2) per 1000 days of drainage. The incidence rate of drainage-associated meningitis did not significantly correlate with different neurosurgical diseases, but there was a tendency for meningitis to predominate in EVD patients with vascular pathology of the central nervous system (CNS). The rate of artery catheterization for direct measurement of systemic BP and the use of vasopressor agents were significantly higher in the group of patients with drainage-associated meningitis (p<0.05). ALV was used in 98 (99%) of 99 patients with drainage-associated meningitis; respiratory support was used in 325 (80.8%) patients without meningitis (p<0.01). An analysis of the ventricular drainage duration revealed a significantly (p<0.05) larger number of days of using EVD in the group of patients with drainage-associated meningitis. In most critical care patients (57.6%), meningitis developed during the first week of drainage. Cerebrospinal fluid leakage occurred significantly more frequently in patients with drainage-associated meningitis than in patients with EVD and without meningitis (p<0.01). Based on a microbiological examination, the etiology of drainage-associated meningitis was established in 57.1% of cases. The leading pathogens were coagulase-negative staphylococci (48.3%) and Acinetobacter baumannii (18.3%).

The incidence rate of drainage-associated meningitis was 19.8 per 100 patients and 18.3 per 1000 days of drainage. The risk factors significantly predominating in patients with drainage-associated meningitis include the duration of drainage, association with external CSF leakage, as well as factors associated with indicators of the overall severity of the condition.