Empirical Combination Antibiotic Therapy Improves the Outcome of Nosocomial Meningitis or Ventriculitis in Neuro-Critical Care Unit Patients

Abstract

Nosocomial meningitis and ventriculitis (MEN) are serious complications in neuro-critical care unit (NCCU) patients. Few data are available on the risk factors and mortality rates among NCCU patients with these disorders caused by multi-drug-resistant (MDR) pathogens. Our aim was to identify the risk factors for MEN caused by such pathogens and in-hospital deaths in critically ill neurologic patients and to evaluate the impact of empirical combination antibiotic therapy (ECAT) on the outcomes of these patients. We conducted a retrospective study of critically ill neurologic patients having nosocomial MEN who were admitted to the NCCU in a university teaching hospital from January 2003 to December 2013, with MEN being defined using the modified U.S. Centers for Disease Control and Prevention criteria for nosocomial infections. In total, 6,149 consecutive NCCU patients were screened; 132 had MEN. Logistic regression analysis demonstrated that MDR MEN was related to infection with gram-negative (GN) bacteria (odds ratio 3.16; 95% confidence interval [CI] 1.08-9.25; p = 0.036), and inadequate initial antibiotic therapy (odds ratio 9.80; 95% CI 3.79-25.32; p < 0.001). The ECAT was associated with a lower mortality rate (hazard ratio 0.35; 95% CI 0.14-0.86; p = 0.022) in Cox proportional hazard regression analysis. The other variable independently associated with a greater mortality rate was a greater Simplified Acute Physiology Score II (hazard ratio 1.07; 95% CI 1.01-1.13; p = 0.018). Initial combination therapy improves the in-hospital mortality rate among NCCU patients with nosocomial MEN. Inadequate initial antibiotic therapy and GN infection were associated with MDR MEN.