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Predictors of mortality in post-neurosurgical Gram-negative bacterial meningitis: a five-year retrospective study

Bahar Ormen1, Hasan K Sucu2, Cansu Aksoy Aksit1

  • 1Infectious Diseases, Katip Celebi University Atatürk Training and Research Hospital, Izmir, Turkey.

Journal of Infection in Developing Countries
|July 10, 2026
PubMed
Abstract

Insights

In post-neurosurgical Gram-negative bacterial meningitis (GNBM), low lymphocyte-to-platelet ratio (LPR) and high neutrophil-to-lymphocyte ratio (NLR) predict mortality. These biomarkers aid early risk stratification in GNBM patients.

Area of Science:

  • Infectious Diseases
  • Critical Care Medicine
  • Clinical Pathology

Background:

  • Gram-negative bacterial meningitis (GNBM) incidence is rising post-neurosurgery.
  • Antimicrobial resistance in Gram-negative pathogens increases GNBM morbidity and mortality.
  • Identifying mortality predictors in post-neurosurgical GNBM (PN-GNBM) is crucial.

Purpose of the Study:

  • To identify clinical and laboratory parameters associated with mortality in PN-GNBM.
  • To evaluate the predictive value of leukocyte ratios for mortality in PN-GNBM.
  • To assess the utility of NLR and LPR as biomarkers for PN-GNBM outcomes.

Main Methods:

  • Retrospective study of adult patients with PN-GNBM (diagnosed >48h post-neurosurgery).
  • Inclusion of clinical and laboratory data from January 2019 to March 2024.
  • Statistical analysis to determine factors associated with 28-day all-cause mortality.

Main Results:

  • The 28-day mortality rate in PN-GNBM was 60%.
  • Low lymphocyte-to-platelet ratio (LPR) significantly predicted mortality at 7, 14, and 21 days (p < 0.05).
  • High neutrophil-to-lymphocyte ratio (NLR) predicted 14-day mortality (p = 0.035).
  • Acinetobacter baumannii was the most common pathogen, with 81.81% carbapenem resistance.

Conclusions:

  • NLR and LPR are accessible biomarkers for early mortality prediction in PN-GNBM.
  • These ratios can aid in risk stratification for PN-GNBM patients.
  • Further validation in larger multicenter studies is recommended.
Keywords:
Gram-negative bacterialymphocyte-to-monocyte ratiolymphocyte-to-platelet ratiomortalityneutrophil-to-lymphocyte ratiopost-neurosurgical meningitis

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