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Hospital-acquired bacterial meningitis in neurosurgical patients
Abstract:
The authors review 23 cases of hospital-acquired meningitis occurring over a 15 year period in neurosurgical patients. Factors associated with the development of meningitis include recent craniotomy, cerebrospinal fluid leak, the presence of ventricular or lumbar drainage tubes, and skull fracture. Four cases were caused by Staphylococcus epidermidis; one of these patients died. In 19 cases, Gram-negative enteric bacteria were the etiologic agents, most commonly members of the Klebsiella-Enterobacter-Serratia group. Eleven of these patients died. The particular antibiotic or group of antibiotics used and the route of administration made no difference in the outcome of Gram-negative bacillary meningitis.
Insights
Hospital-acquired meningitis in neurosurgical patients is often caused by Gram-negative bacteria, leading to high mortality. Risk factors include recent surgery and drainage tubes, with antibiotic choice not impacting outcomes.
Area of Science:
- Neuroscience
- Infectious Diseases
- Hospital Epidemiology
Background:
- Hospital-acquired meningitis poses a significant risk to neurosurgical patients.
- Identifying risk factors and causative agents is crucial for effective management.
Purpose of the Study:
- To analyze the characteristics and outcomes of hospital-acquired meningitis in neurosurgical patients.
- To identify predisposing factors and common pathogens.
Main Methods:
- Retrospective review of 23 cases of hospital-acquired meningitis over 15 years.
- Analysis of patient data, including neurosurgical procedures, interventions, and microbiological findings.
Main Results:
- Common risk factors identified: recent craniotomy, cerebrospinal fluid leak, drainage tubes, and skull fracture.
- Gram-negative enteric bacteria, particularly Klebsiella-Enterobacter-Serratia group, were the most frequent cause (19 cases).
- Staphylococcus epidermidis caused 4 cases, with one fatality; Gram-negative meningitis resulted in 11 deaths.
Conclusions:
- Hospital-acquired meningitis in neurosurgical patients is associated with significant morbidity and mortality.
- Gram-negative bacteria are the predominant pathogens, and outcomes are not influenced by antibiotic therapy.
- Preventive strategies targeting risk factors are essential.