Risk Factors For Meningitis Research Articles

A Little Neutrophil Predominance May Not Be a Harbinger of Death: Clinical and Laboratory Characteristics of Meningitis in Jordan.

Background This study aims to evaluate the clinical features, laboratory findings, and outcomes of children and adults diagnosed with meningitis in Jordan. Methodology This is a retrospective chart review study that targeted patients diagnosed with meningitis at King Abdullah University Hospital, a tertiary care center in Northern Jordan, from March 21, 2015, to March 31, 2019. Patients were included in this study if they were older than 28 days and had no risk factors for meningitis. Results A total of 169 patients met the inclusion criteria. Males were overrepresented (67%) and were significantly younger than females (6 vs. 17 years, p = 0.01). Positive meningeal signs were not predictive of greater cerebrospinal fluid leukocytosis (p = 0.348), and they did not provide sufficient sensitivity to be used as screening tools. The most common etiology was aseptic (49%), followed by enterovirus (43%), while bacterial meningitis was an uncommon diagnosis (3.5%). Nearly half of the patients took antibiotics prior to their hospital presentation. During in-hospital admission, six patients died, four of whom had bacterial and two had aseptic meningitis. Enteroviral meningitis showed neutrophil predominance in 44% of cases on lumbar puncture and had a higher neutrophil proportion compared to aseptic meningitis (p = 0.026). Streptococcus pneumoniae was the most common bacterial etiology identified. Conclusions Meningitis in Jordan is most commonly of aseptic and enteroviral origin, and these etiologies carry significantly more favorable outcomes compared to bacterial meningitis. Enteroviral meningitis displays a higher percentage of neutrophils in cerebrospinal fluid compared to aseptic meningitis. S. pneumoniae is the leading cause of bacterial meningitis.Slight neutrophil predominance above halfis a weak predictor of bacterial meningitis due to the small contribution of bacteria asa cause among enteroviruses and aseptic etiologies.

Etiology and Risk Factors for Meningitis during an Outbreak in Batié Health District, Burkina Faso, January-March 2016

INTRODUCTION: On 16 March 2016, Batié Health District notified the Burkina Faso Min-istry of Health Surveillance unit of 12 suspected cases of meningitis. During the same period, Batié’s neighboring districts in Côte d´Ivoire and Ghana were experiencing a meningitis epi-demic. We investigated to establish the etiology and risk factors for the disease and to recommend prevention and control measures. METHODS: We conducted unmatched case-control study. A case was any person living in Batié with fever (temp. ? 38.5°C) and any of the following: neck stiffness, neurological disor-der, bulging fontanelle, convulsion during January to April 2016 with cerebrospinal fluid (CSF) positive to PCR. Controls were non sick household members, neighbors or friends to the cases. We analyzed the investigation and laboratory records. We included all confirmed cases and two neighborhood controls per case. We used a standard questionnaire to collect data. We analyzed data by Epi info 7 and calculated odds ratio (ORs),adjusted odds ratios (AOR) and 95% confidence interval. We proceeded to univariate, bivariate, multivariate and logistic re-gression analysis. RESULTS: We interviewed 93 participants including 31 meningitis cases and 62 controls. The median age of cases was 8 years old [2 months-55 years] and 6.5 years old [5 months-51 years] for controls. <i>Streptococcus pneumoniae </i>16(51.61%), <i>Neisseria meningitidis W </i>14(45.16%) and <i>Haemophilus influenzae </i>b 1(3.23%) were the identified germs. The independent risk factors identified were travel to meningitis affected areas (Adjusted odd ra-tio(AOR)=12[2.3-60],p=0.0029); >5 persons sharing bedroom (AOR=5.7[1.5-22],p=0.012) and rhino-pharyngitis (AOR=26[1.8-380],p=0.017).CONCLUSION: Streptococcus pneumoniae and Neisseria meningitidis W caused the out-break in Batié. The risk factors were overcrowding, travel to affected areas, and rhino-pharyngitis. We recommended reactive vaccination against Neisseria meningitidis W, limited travel to affected areas and ventilation of rooms.

Clinical Profile of Bacterial Meningitis in Children and Comparative Inter-Alia Analysis of Various Microbiological Tests

Acute Bacterial meningitis is life-threatening and neurologically debilitating infectious disease. We studied the clinical profile,organisms involved in bacterial meningitis in children and compared tests on Cerebrospinal Fluid (CSF) Latex Agglutination Test (LAT), Polymerase Chain Reaction (PCR), gram stain (conventional), cyto-tek centrifuge cytospin gram stain to culture which is the gold standard .Methods: Ours was a observational cross- sectional study (age range 3 to 12 years) conducted in a tertiary care hospital, New delhi, India for one year. Total of 101 patients were enrolled and divided in 3 age groups viz 5years. Fever was the most common presenting symptom in all groups (84.2%). Refusal to feed, headache, altered sensorium, vomiting, blurring of vision were significantly associated with bacterial meningitis in all age groups. Cranial nerve palsies and neck rigidity were significantly higher in older children. Age<5years, low socioeconomic status, overcrowding and smoke exposure were identified as risk factors for meningitis. 8 children died within 48 hours of admission in our study the rest had a normal recovery. CSF culture was positive in 35.6% cases with streptococcus pneumoniae being the most common organism. PCR performed best for the diagnosis of meningitis but it has its limitations. Cytospin gram stain showed positivity in 65% cases which much higher compared to conventional gram stain. Cytospin gram stain was a viable low-cost alternative for early diagnosis of meningitis in low income countries like ours.

Patients With Inflammatory Bowel Diseases Are at Higher Risk for Meningitis.

The epidemiology of meningitis is unknown in inflammatory bowel disease (IBD) patients. We aimed to determine the incidence of and risk factors for meningitis in IBD patients. We conducted a retrospective cohort and nested case-control study in the Quintiles IMS Legacy PharMetrics Adjudicated Claims Database from January 2001 to June 2016. We matched IBD patients to those without IBD on age, sex, enrollment, and region. Meningitis was defined as one code for meningitis associated with an emergency department visit or hospitalization. Meningitis risk was calculated with incidence rate ratios. In a nested case-control study of IBD patients, predictors for meningitis were determined with multivariable conditional logistic regression models. We identified 50,029 patients with Crohn's disease (CD) and 59,830 patients with ulcerative colitis (UC) matched to 296,801 non-IBD comparators. There were 85 CD patients, 77 UC patients, and 235 comparators with meningitis. CD patients had 2.17 times the rate of meningitis and UC patients had 1.63 times the rate of meningitis as non-IBD comparators. After adjusting for relevant covariates among those with IBD, treatment with mesalamine was associated with a significantly lower odds of a meningitis claim (odds ratio: 0.40, 95% confidence interval: 0.26-0.62). Having at least one comorbidity was associated with a significantly higher odds of a meningitis claim (odds ratio: 2.21, 95% confidence interval: 1.76-2.77). Although the overall rate of meningitis is low, IBD patients are at an increased risk compared with non-IBD comparators. Comorbidities are a risk factor for meningitis in IBD patients. Pneumococcal and meningococcal vaccinations should be discussed.

Clinical Profile of Bacterial Meningitis in Children and Comparative Inter-Alia Analysis of Various Microbiological Tests

AbstractAcute bacterial meningitis (ABM) is a life-threatening and neurologically debilitating infectious disease. We studied the clinical profile, organisms involved in bacterial meningitis in children, and compared the tests on cerebrospinal fluid (CSF), latex agglutination test (LAT), polymerase chain reaction (PCR), Gram stain (conventional) and Cyto-Tek cytospin centrifuge Gram stain to culture which is the gold standard. This was an observational cross-sectional study (age range 3 to 12 months) conducted in a tertiary care hospital, New Delhi, India over 1 year. A total of 101 patients were enrolled and divided into three age groups, namely, &lt; 1 year, 1 to 5 years, and &gt; 5 years. Fever was the most common presenting symptom in all groups (84.2%). Refusal to feed, headache, altered sensorium, vomiting, and blurring of vision were significantly associated with bacterial meningitis in all age groups. Cranial nerve palsies and neck rigidity were significantly higher in older children. Age &lt; 5years, low-socioeconomic status, overcrowding, and smoke exposure were identified as risk factors for meningitis. Eight children died within 48 hours of admission and the rest (n = 93) recovered without complications. CSF culture was positive in 35.6% cases, with streptococcus pneumoniae being the most common organism. PCR was most sensitive (86.1%) and cytospin gram stain showed positivity in 65% cases which was statistically higher compared with conventional gram stain. Cytospin-prepared Gram stain was a viable low-cost alternative for early diagnosis of meningitis in low-income countries like India.

Incidence and clinico-demographic characteristics of neonatal meningitis in clinically suspected sepsis: an observational study

Background: Authors objective was to study the incidence and risk factors for meningitis in neonates with clinical suspicion of sepsis in Neonatal Intensive Care Unit (NICU) of tertiary care hospital of Mumbai, India.Methods: This descriptive observational study enrolled Consecutive 92 patients of either sex with suspected neonatal sepsis admitted in NICU of Tertiary Care Hospital. All neonates admitted to NICU with clinical suspicion of sepsis or developing signs of sepsis during NICU stay were included in study. Exclusion criteria were 1.Neonates with hemodynamic instability 2.major congenital malformations 3.contraindication or no willingness for Lumber puncture (LP ) 4.neonates who have received intravenous antibiotics for more than 24 hours elsewhere.Standard data collection form was used to collect all demographic data and clinical characteristics of neonates.Results: Incidence of meningitis in study population was 7.6%. Cases of meningitis in study population had mean birth weight 1.91 kg, 71.43% were preterm, 57.14% vaginaly delivered, 42.86% by LSCS, Premature rupture of membrane (PROM) observed in 28.57% cases. Meconium stained liquor in 42.86% cases and foul smelling liquor in 28.57% cases observed. 42.86% cases required resuscitation and 28.57% received surfactant therapy. Poor feeding (100%), lethargy (85.71%), weak cry (85.71%) and tachypnea (50.58%). Retractions (85.71%), Grunting (57.14%) and Nasal flaring (42.86%) were clinical presentation. Lab findings in a case of meningitis: mean Hemoglobin (Hb) 15.22 gm%, Leukopenia (28.57%), Leukocytosis 28.57%, Absolute Neutrophil count (ANC) &lt;1800 (28.57%), Thrombocytopenia 42.85%, blood culture positive (28.57%) hypoglycemia (28.57%), CSF white cell count (124.57cells/ml.), mean CSF protein level (60 mg/dl.) Mean CSF glucose level (40.86 mg/dl.) CSF culture was positive in two cases of meningitis.Conclusions: Authors study highlights the diagnostic utility of routine lumbar puncture in neonates with clinically suspected sepsis.

Epidemiological and lethal risk factors of Klebsiella pneumoniae infection in neurosurgical patients

Objective We performed a retrospective study to determine the epidemiological characteristics of Klebsiella pneumoniae infection after neurosurgery and to elucidate the risk. Methods Patients who underwent neurosurgery between January 2012 and December 2016 were included.Demographic, clinical, laboratory, and microbiological data were systemically recorded.17 clinical trials and 7 clinical laboratory indicators were evaluated as risk factors for meningitis. Results Forty-five cases of neurosurgery patients led to K. pneumoniae infection were analyzed, K.pneumoniae ESBLs production ratio is 37.8%(17/45), the sensitivity rate of carbapenem antibiotics was more than 80.0%(36/45). The patients were mainly in the north of China with an average age of 36.3±18.3 years old and a male ratio of 53.3%(24/45). The highest proportion of patients are pituitary adenoma and glioblastoma and the mortality rate was 22.2%(10/45). The mean length of hospital stay was 29.2±13.7 days, and the most likely to develop K. pneumoniae were 7.8±6.9 days after neurosurgery.The ICU occupancy rate was 51.1%(23/45). Chi-square test showed that older age (>50 years old) and sepsis were risk factors for death from K. pneumoniae infection after neurosurgery.Multivariate logistic analysis showed that the risk of infection was associated with the incidence of sepsis (OR 16.199, P=0.010). There were no statistically significant differences between the survival and death patients by seven laboratory tests(P>0.05). Conclusion The infection of neurosurgery caused by K. pneumoniae has a high mortality rate.Among them, concurrent sepsis is the lethal risk factor of infection.Clinically, identification of the risk factors as soon as possible will help physicians to improve patient care and improve the surgical success. Key words: Postoperative infection; Klebsiella pneumoniae; Risk factors; Neurosurgery

2145. Etiology, Incidence and Risk Factors for Meningitis after Craniotomy

BackgroundMeningitis after craniotomy can be devastating. The objective of our study is to answer four questions: (a) what is the risk of meningitis after craniotomy? (b) What are the main microorganisms causing meningitis after craniotomy? (c) What is the impact of meningitis in the hospital length of stay and mortality? (d) What are risk factors for meningitis after craniotomy?MethodsSurveillance data based on NHSN/CDC protocols were collected between 2013 and 2017 from nine hospitals at Belo Horizonte, Brazil. Outcome: meningitis, hospital death and total length of hospital stay. Twenty-three independent variables were analyzed using Epi Info and applying statistical two-tailed test hypothesis with significance level of 5%.ResultsA sample of 4,549 patients submitted to craniotomy was analyzed: risk of meningitis = 1.9% (IC 95% = 1.6%; 2.4%). Mortality rate in patients without infection was 9% rising to 33% in infected patients (P < 0.01). Hospital length of stay in non-infected patients (days): mean = 18, median = 7, std. dev. = 36. Hospital stay in infected patients: mean = 56, median = 37, std. dev. = 63 (P < 0.001). The duration of procedure was the main risk factor for meningitis: 1.5% risk of meningitis in surgery less than or equal to 4 hours vs. 2.5% if the duration of procedure was more than 4 hours (relative risk = 1.7; P = 0.041). From 88 meningitis, in 68 (77%) the etiologic agent was identified: Klebsiella pneumoniae (20%), Staphylococcus aureus (16%), Acinetobacter baumannii (13%), Pseudomonas aeruginosa (9%), Staphylococcus sp. (8%), Acinetobacter sp. (7%), Staphylococcus epidermidis (5%), and other (20%).ConclusionThe study showed how much meningitis is devastating, rising the death risk and length of hospital stay.Disclosures All authors: No reported disclosures.

Global, regional, and national burden of meningitis, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

SummaryBackgroundAcute meningitis has a high case-fatality rate and survivors can have severe lifelong disability. We aimed to provide a comprehensive assessment of the levels and trends of global meningitis burden that could help to guide introduction, continuation, and ongoing development of vaccines and treatment programmes.MethodsThe Global Burden of Diseases, Injuries, and Risk Factors (GBD) 2016 study estimated meningitis burden due to one of four types of cause: pneumococcal, meningococcal, Haemophilus influenzae type b, and a residual category of other causes. Cause-specific mortality estimates were generated via cause of death ensemble modelling of vital registration and verbal autopsy data that were subject to standardised data processing algorithms. Deaths were multiplied by the GBD standard life expectancy at age of death to estimate years of life lost, the mortality component of disability-adjusted life-years (DALYs). A systematic analysis of relevant publications and hospital and claims data was used to estimate meningitis incidence via a Bayesian meta-regression tool. Meningitis deaths and cases were split between causes with meta-regressions of aetiological proportions of mortality and incidence, respectively. Probabilities of long-term impairment by cause of meningitis were applied to survivors and used to estimate years of life lived with disability (YLDs). We assessed the relationship between burden metrics and Socio-demographic Index (SDI), a composite measure of development based on fertility, income, and education.FindingsGlobal meningitis deaths decreased by 21·0% from 1990 to 2016, from 403 012 (95% uncertainty interval [UI] 319 426–458 514) to 318 400 (265 218–408 705). Incident cases globally increased from 2·50 million (95% UI 2·19–2·91) in 1990 to 2·82 million (2·46–3·31) in 2016. Meningitis mortality and incidence were closely related to SDI. The highest mortality rates and incidence rates were found in the peri-Sahelian countries that comprise the African meningitis belt, with six of the ten countries with the largest number of cases and deaths being located within this region. Haemophilus influenzae type b was the most common cause of incident meningitis in 1990, at 780 070 cases (95% UI 613 585–978 219) globally, but decreased the most (–49·1%) to become the least common cause in 2016, with 397 297 cases (291 076–533 662). Meningococcus was the leading cause of meningitis mortality in 1990 (192 833 deaths [95% UI 153 358–221 503] globally), whereas other meningitis was the leading cause for both deaths (136 423 [112 682–178 022]) and incident cases (1·25 million [1·06–1·49]) in 2016. Pneumococcus caused the largest number of YLDs (634 458 [444 787–839 749]) in 2016, owing to its more severe long-term effects on survivors. Globally in 2016, 1·48 million (1·04—1·96) YLDs were due to meningitis compared with 21·87 million (18·20—28·28) DALYs, indicating that the contribution of mortality to meningitis burden is far greater than the contribution of disabling outcomes.InterpretationMeningitis burden remains high and progress lags substantially behind that of other vaccine-preventable diseases. Particular attention should be given to developing vaccines with broader coverage against the causes of meningitis, making these vaccines affordable in the most affected countries, improving vaccine uptake, improving access to low-cost diagnostics and therapeutics, and improving support for disabled survivors. Substantial uncertainty remains around pathogenic causes and risk factors for meningitis. Ongoing, active cause-specific surveillance of meningitis is crucial to continue and to improve monitoring of meningitis burdens and trends throughout the world.FundingBill & Melinda Gates Foundation.

Evolution of the graded repair of CSF leaks and skull base defects in endonasal endoscopic tumor surgery: trends in repair failure and meningitis rates in 509 patients.

The authors previously described a graded approach to skull base repair following endonasal microscopic or endoscope-assisted tumor surgery. In this paper they review their experience with skull base reconstruction in the endoscopic era. A retrospective review of a single-institution endonasal endoscopic patient database (April 2010–April 2017) was undertaken. Intraoperative CSF leaks were graded based on size (grade 0 [no leak], 1, 2, or 3), and repair technique was documented across grades. The series was divided into 2 epochs based on implementation of a strict perioperative antibiotic protocol and more liberal use of permanent and/or temporary buttresses; repair failure rates and postoperative meningitis rates were assessed for the 2 epochs and compared. In total, 551 operations were performed in 509 patients for parasellar pathology, including pituitary adenoma (66%), Rathke’s cleft cyst (7%), meningioma (6%), craniopharyngioma (4%), and other (17%). Extended approaches were used in 41% of cases. There were 9 postoperative CSF leaks (1.6%) and 6 cases of meningitis (1.1%). Postoperative leak rates for all 551 operations by grade 0, 1, 2, and 3 were 0%, 1.9%, 3.1%, and 4.8%, respectively. Fat grafts were used in 33%, 84%, 97%, and 100% of grade 0, 1, 2, and 3 leaks, respectively. Pedicled mucosal flaps (78 total) were used in 2.6% of grade 0–2 leaks (combined) and 79.5% of grade 3 leaks (60 nasoseptal and 6 middle turbinate flaps). Nasoseptal flap usage was highest for craniopharyngioma operations (80%) and lowest for pituitary adenoma operations (2%). Two (3%) nasoseptal flaps failed. Contributing factors for the 9 repair failures were BMI ≥ 30 (7/9), lack of buttress (4/9), grade 3 leak (4/9), and postoperative vomiting (4/9). Comparison of the epochs showed that grade 1–3 repair failures decreased from 6/143 (4.1%) to 3/141 (2.1%) and grade 1–3 meningitis rates decreased from 5 (3.5%) to 1 (0.7%) (p = 0.08). Prophylactic lumbar CSF drainage was used in only 4 cases (< 1%), was associated with a higher meningitis rate in grades 1–3 (25% vs 2%), and was discontinued in 2012. Comparison of the 2 epochs showed increase buttress use in the second, with use of a permanent buttress in grade 1 and 3 leaks increasing from 13% to 55% and 32% to 76%, respectively (p < 0.001), and use of autologous septal/keel bone as a permanent buttress in grade 1, 2, and 3 leaks increasing from 15% to 51% (p < 0.001). A graded approach to skull base repair after endonasal surgery remains valid in the endoscopic era. However, the technique has evolved significantly, with further reduction of postoperative CSF leak rates. These data suggest that buttresses are beneficial for repair of most grade 1 and 2 leaks and all grade 3 leaks. Similarly, pedicled flaps appear advantageous for grade 3 leaks, while CSF diversion may be unnecessary and a risk factor for meningitis. High BMI should prompt an aggressive multilayered repair strategy. Achieving repair failure and meningitis rates lower than 1% is a reasonable goal in endoscopic skull base tumor surgery.

Etiology and risk factors for meningitis and/or bacteremia after craniotomy for patients with glioma

To evaluate the incidence and microbiological profile of meningitis and/or bacteremia after craniotomy in patients with glioma and analyze the risk factors relevant to postoperative meningitis. Methods: All demographic data, etiological data and clinical data for hospitalized patients who underwent craniotomy in Dept. of Neurosurgery of Peking Union Medical College Hospital between Jan. 2013 to Dec. 2017 were recorded. Results: The incidence of post-craniotomy meningitiswas 7.73%, bacteremia was 2.21% and meningitis combined with bacteremia was 1.10%. The positive rate for cerebrospinal fluid culture was 78.57%. Among the 11 cases of meningitis, 20 bacteria were detected, and the most common gram-positive bacteria were: epidermal Staphylococcus (3 case, 15.0%), and hemolytic Staphylococcus (3 case, 15.0%); the most common gram-negative one was Klebsiella pneumoniae (2 case, 10.0%). Among the 5 cases of bacteremia, Klebsiella pneumoniae was the most common one (3 cases, 60.0%). Most of the gram-positive bacteria were sensitive to vancomycin and were resistant to penicillin G. Most of the gram-negative bacteria were sensitive to the 3rd generation of cephalosporin and meropenem. Among all the 16 patients, 13 were good in prognosis (81.3%) while 3 (18.8%) were poor in prognosis, with 2 deaths and 1 discharged automatically. Among the 11 patients with meningitis, 7 patients (63.6%) were male and 7(63.6%) were older than 50 years old. The lesionsin the 6 patients located in the frontal lobe (54.5%) and the glioma in 6 patients was at WHO grade IV (54.5%). Three patients were diagnosed as diabetes before the surgery (27.3%). Conclusion: Postoperative meningitis and bacteremia can occur in patients with glioma. The pathogens and drug susceptibility are different. The risk factors for meningitis after craniotomy should be concerned before making a treatment plan.

Diarrhea-associated pneumococcal meningitis with complicating hydrocephalus in a child in a resource-limited setting

Streptococcus pneumonia is the most common and intimidating cause of childhood meningitis. Its delayed diagnosis may be associated with hyponatremia and hypernatremia with fatal outcome. A previously healthy nine-month-old Bangladeshi female infant was diagnosed with diarrhea, pneumonia, and convulsion due to hypernatremia. Pneumonia was confirmed by respiratory distress and radiological findings. Routine cerebrospinal fluid study detected pneumococcal meningitis. Ampicillin, gentamicin, and dexamethasone were promptly started. On day three of hospitalization, convulsion re-appeared with worsening of consciousness level. Antibiotics were switched to ceftriaxone and vancomycin, although ultrasonography of the brain revealed no abnormality. Contrast-enhanced computed tomography scan of the head was performed and revealed dilated ventricles with diffused enhancement of meninges and basal cisterns, demonstrating meningitis with ventriculomegaly. Ceftriaxone was replaced by meropenem to control fever. Magnetic resonance imaging (MRI) of the brain confirmed the progression of hydrocephalus. An emergency ventriculo-peritoneal (VP) shunt operation was performed with continuation of antibiotics for 21 days. After three months, follow-up MRI showed reduction of ventricular size with functioning VP shunt in situ with no neurological deficits. Childhood pneumococcal meningitis may be associated with diarrhea, pneumonia, and other related complication. Appropriate antibiotic therapy alone may not be sufficient to avert complications. Communicating hydrocephalus is potentially an ominous ramification of meningitis even when the ultrasonography result is normal. Rapid diagnosis is imperative to attain good outcome. Evidence advocates further research into the risk factors of meningitis in diarrheal children that may help in early diagnosis and management to reduce meningitis-related fatal outcome.

Risk factors for meningitis after craniotomy in patients with subarachnoid hemorrhage due to anterior circulation aneurysms rupture

ObjectivesPostoperative meningitis is a serious complication occurring after neurosurgical interventions. However, few investigations have focused specifically on the risk factors that predispose patients to meningitis after major craniotomy. This study identified the risk factors for postoperative meningitis after neurovascular surgery, and investigated the relationship between postoperative meningitis and clinical outcome. Patients and methodsA total of 148 consecutive patients with subarachnoid hemorrhage (SAH) who underwent clipping surgery through a pterional approach within 72h between January 2007 and September 2011 were retrospectively analyzed. The treatment strategy of our hospital for patients with SAH was based on the findings of digital subtraction angiography in the acute phase. Coil embolization was firstly considered, and clipping through craniotomy if indicated was performed as soon as possible. Prophylactic antibiotics were administered before beginning craniotomy and for at least 3 days after. Hydrocortisone was used to prevent hyponatremia if allowed by the medical condition of the patient. Intrathecal administration of nicardipine hydrochloride was given if required for vasospasm treatment. Meningitis was clinically diagnosed from the blood samplings and cerebrospinal fluid (CSF) examinations. Data were collected from the electronic and paper charts. The status of modified Rankin scale (mRS) 0–2 at discharge was defined as favorable outcome. ResultsA total of 14 patients (9.5%) had meningitis during this study period. Symptomatic vasospasm was detected in 33 patients (22.3%), and 12 patients (8.1%) had permanent neurological deficits caused by vasospasm. Overall, 109 patients (73.6%) had favorable outcome. The longer duration of drainage placement, presence of CSF leakage, and intrathecal administration of vasodilatory agent showed significantly higher incidence of postoperative meningitis in univariate analysis (p=0.0093, 0.0017, and 0.0090, respectively). The proportion of favorable outcome patients at discharge (mRS 0–2) was significantly lower in patients with postoperative meningitis (35.7%) than in patients without it (77.6%) (p=0.0004). The duration of in-hospital stay was significantly longer in patients with postoperative meningitis (median 58.5, range 28–115 days) than in patients without it (median 38.5, range 19–149 days) (p<0.001). Multivariate logistic regression analysis showed that only presence of CSF leakage was associated with postoperative meningitis (p=0.0299). ConclusionMeningitis after surgery is still a serious complication that requires preventative intervention. The clinical outcome of patients with postoperative meningitis after neurovascular surgery is not still satisfactory.

Actual facts about bacterial meningitis

Background Bacterial meningitis still represents an important chapter in the present infectious pathology, despite the increasing progress in the prophylaxis and prevention measures. Apart from tuberculous etiology, and of course the well-known classical etiologies – meningococcal, pneumococcal, Haemophilus influenzae, staphylococcal and Gram-negative bacteria – new entities that need to be evaluated seem to appear. Objectives: 1. To determine the incidence of bacterial meningitis in the last years, in comparison with the international situation encountered in this pathology. 2. To detect new predisposing and risk factors for meningitis. 3. The important role of procalcitonin and other markers for the quick diagnosis of meningitis. 4. The utilization in the current medical practice of modern molecular diagnostic tests, especially for the severe and atypical cases.

The incidence and risk factors of meningitis after major craniotomy in China: a retrospective cohort study.

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.

Prospective surveillance of drain associated meningitis/ventriculitis in a neurosurgery and neurological intensive care unit

Objectives:There are currently no data available on drain associated infection occurrence related to the number of drainage days (DD), and thus drain associated infection rates. Therefore, a prospective surveillance study...

Close contact with children may be risk factor for meningitis

Close contact with children may be risk factor for meningitis

Incidence of meningitis and of death from all causes among users of cochlear implants in the United Kingdom

During 2002, there was an increase in reports of bacterial meningitis among people with cochlear implants in Europe and North America. One model of implant, which included a space-occupying 'positioner', was recalled. Implantation of a positioner was shown to be a risk factor for meningitis among children in the United States. The situation in the United Kingdom was not known. We ascertained the cohort of people who had received cochlear implants with intra-cochlear electrodes in UK hospitals prior to 1 October 2002 and were permanently resident in the United Kingdom. We compared the incidence of meningitis, and the causes and incidence of death from all causes, between the cohort and reference populations. Of 1851 children (66 with positioners), none had contracted meningitis. Neither the incidence rate of meningitis, nor the cumulative mortality from all causes, differed significantly between implanted children and values expected for the general population. Of 1779 adults (139 with positioners), five had contracted meningitis with three fatalities. No case of meningitis involved a positioner and four of the cases, including the fatalities, possessed risk factors unrelated to implantation. Although the incidence rate of meningitis was significantly higher in implanted adults than the general population, cumulative mortality from all causes was never higher, and was significantly lower at some time points after implantation. Specific evidence of the association between bacterial meningitis and implantation with a positioner that arose in the United States and mainland Europe during 2002 has not been found in the United Kingdom.

A case-control study examining risk factors for invasive Haemophilus influenzae type b disease in Victoria, Australia 1988-90.

To determine whether day-care attendance was a risk factor for Haemophilus influenzae type b (Hib) disease, particularly for epiglottitis. A case-control analysis of risk factors for invasive Hib disease was performed in Victoria, Australia between February 1988 and February 1990 prior to the introduction of immunization for Hib. A total of 210 cases and 367 day surgery hospital controls were enrolled prospectively. Data were collected by questionnaire at the time of admission. Logistic regression analysis showed that risk factors for meningitis were day-care attendance, household crowding and recent illness in a sibling. Risk factors for epiglottitis were day-care attendance and mother's birthplace in Australia or New Zealand. This study confirms that day-care attendance is a risk factor for Hib epiglottitis as well as meningitis. In addition, the mother's birthplace in Australia or New Zealand is a risk factor for epiglottitis in these data. The reason for this latter observation is unclear.

Survey of neonatal meningitis in Australia: 1987–1989

To identify incidence, bacterial aetiology, outcome after treatment and risk factors for poor outcome of neonatal meningitis. Retrospective survey of neonatal meningitis occurring in Australia between January 1987 and December 1989. Data were obtained from Medical Records and Microbiology Departments of hospitals with neonatal nurseries. Neonatal nurseries throughout Australia. 116 infants under 6 weeks of age with bacterial or fungal meningitis. The minimum incidence was 0.17 per 1000 live births. Traditional neonatal pathogens were responsible for 60% of cases (group B streptococci, 35%; Escherichia coli, 22%), childhood meningeal pathogens for 10% and opportunistic pathogens for 30%. Risk factors for meningitis, including prematurity, were more common among those with meningitis due to E. coli or opportunistic pathogens than among those with infections due to group B streptococci, Listeria monocytogenes or the childhood pathogens (46/60 v. 11/55; P less than 0.0001). Meningitis was more likely to be due to Gram-negative bacteria in premature infants (less than 36 weeks gestation) than in full-term infants (19/30 v. 20/86; P = 0.0002). The mortality overall was 26% but was higher in extremely premature infants (less than 29 weeks) (6/9 v. 24/107; P = 0.009) and among 13 patients who were judged to have had inappropriate initial therapy (7/13 v. 21/97; P = 0.04). Long-term sequelae occurred in at least 23% of survivors, but were more common in those with Gram-negative meningitis (6/10 v. 13/76; P = 0.012). Initial therapy with penicillin or amoxycillin plus cefotaxime is appropriate for most infants with bacterial meningitis. Since some less common Gram-negative bacteria isolated in this survey were resistant to cefotaxime, an aminoglycoside should be added, initially, in Gram-negative meningitis.