Abstract
BackgroundMeningitis after neurosurgery can result in severe morbidity and high mortality. Incidence varies among regions and limited data are focused on meningitis after major craniotomy.AimThis retrospective cohort study aimed to determine the incidence, risk factors and microbiological spectrum of postcraniotomy meningitis in a large clinical center of Neurosurgery in China.MethodsPatients who underwent neurosurgeries at the Department of Neurosurgery in Huashan Hospital, the largest neurosurgery center in Asia and the Pacific, between 1stJanuary and 31st December, 2008 were selected. Individuals with only shunts, burr holes, stereotactic surgery, transsphenoidal or spinal surgery were excluded. The complete medical records of each case were reviewed, and data on risk factors were extracted and evaluated for meningitis.ResultsA total of 65 meningitides were identified among 755 cases in the study, with an incidence of 8.60%. The risk of meningitis was increased by the presence of diabetes mellitus (odds ratio [OR], 6.27; P = 0.009), the use of external ventricular drainage (OR, 4.30; P = 0.003) and the use of lumbar drainage (OR, 17.23; P<0.001). The isolated microorganisms included Acinetobacter baumannii, Enterococcus sp, Streptococcus intermedius and Klebsiella pneumonia.ConclusionsMeningitis remains an important source of morbidity and mortality after major craniotomy. Diabetic patients or those with cerebral spinal fluid shunts carry significant high risk of infection. Thus, identification of the risk factors as soon as possible will help physicians to improve patient care.
Highlights
Meningitis has posed a formidable challenge in neurosurgery, resulting in severe morbidity with a prolonged length of hospitalization, multiple surgeries and higher hospital costs [1]
Meningitis remains an important source of morbidity and mortality after major craniotomy
It is important for surgeons to identify risk factors and provide empirical treatment according to the local surveillance of pathogens once infection is suspected
Summary
Meningitis has posed a formidable challenge in neurosurgery, resulting in severe morbidity with a prolonged length of hospitalization, multiple surgeries and higher hospital costs [1]. It is important for surgeons to identify risk factors and provide empirical treatment according to the local surveillance of pathogens once infection is suspected. Comprehensive studies have been published [2,3,4,5,6,7,8,9,10,11,12,13,14,15], 2 focusing on the evaluation of risk factors related to surgical site infection including meningitis, only few studies considered specific factors for meningitis after major craniotomy [1,16] 16. We aimed to investigate the incidence of postcraniotomy meningitis at the department of Neurosurgery in Shanghai Huashan Hospital, to analyze the risk factors involved in the development of meningitis and to identify the etiology agents for empirical treatment. Incidence varies among regions and limited data are focused on meningitis after major craniotomy
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