Risk factors for nosocomial meningitis in patients with external ventricular drainages

Area of Science:

• Intensive Care Medicine
• Infectious Diseases
• Neurosurgery

Background:

• External ventricular drain (EVD) placement is crucial for managing intracranial pressure but carries a risk of infection.
• Nosocomial meningitis (NM) following EVD insertion presents diagnostic challenges and impacts patient outcomes.
• Timely diagnosis and treatment are critical for improving prognosis in EVD-associated NM.

Purpose of the Study:

• To investigate the epidemiology of NM in intensive care unit (ICU) patients with EVDs.
• To identify significant risk factors associated with the development of NM in this patient population.
• To develop a predictive model for early NM detection.

Main Methods:

• A retrospective single-center cohort study was conducted involving adult patients who received EVDs between 2018 and 2022.
• Patients were categorized into NM and non-NM groups based on clinical, biological, and microbiological criteria.
• Risk factors including patient demographics, device characteristics, and clinical data were analyzed.

Main Results:

• Out of 275 EVD patients, 32 (11.6%) developed NM, experiencing longer ICU stays but similar mortality rates.
• Significant risk factors for NM included cerebrospinal fluid (CSF) leakage, prolonged drainage duration, beta-lactam allergy, and specific CSF cytochemical profiles.
• A predictive model demonstrated strong performance with an AUC-ROC of 0.89 and a negative predictive value of 96.8%.

Conclusions:

• Beta-lactam allergy, CSF leakage, extended drainage duration, and specific CSF laboratory findings are key predictors of NM.
• The developed predictive model offers a valuable tool for the early identification and management of NM in EVD patients.
• Early detection through this model can facilitate timely treatment, potentially improving patient outcomes.