Delayed diagnosis in postoperative bacterial meningitis: A retrospective study in the skull base neoplasm surgery

Postoperative bacterial meningitis (PBM), a severe complication after skull base tumor surgery, poses a challenge in early diagnosis, which is crucial yet often delayed due to the inconclusive nature of current diagnostic methods relying on clinical symptoms and CSF analysis. This study aimed to identify factors associated with delayed PBM diagnosis and improve early detection strategies by comparing clinical and laboratory differences between patients diagnosed within 7 days (Timely Infection Diagnosis, TID) and those diagnosed more than 7 days (Delayed Infection Diagnosis, DID) after surgery.

This retrospective study included 372 patients diagnosed with PBM after skull base tumor surgery at our institution from January 2019 to August 2024. Patients were divided into TID and DID groups. Multivariate analysis identified time between first lumbar puncture and surgery, tumor located in posterior fossa, and multinucleated cell ratio as independent factors differing between the groups.

Compared to TID cases, patients in DID group consist more of craniotomy and posterior tumor location, and they showed less severe early symptoms and CSF findings but had longer infection duration following antibiotic treatment. The study highlights the limitations of relying solely on initial CSF results and emphasizes the need for clinical vigilance, perioperative management, and individualized diagnostic strategies in suspected PBM.