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VOLUME 26 , ISSUE 12 ( December, 2022 ) > List of Articles

Original Article

Bacterial Meningitis among Intracranial Surgery Patients at a University Hospital in Northern India

Keywords : Bacterial meningitis, External ventricular drain, Multidrug resistance, Post-neurosurgery patients, Tertiary care center

Citation Information : Bacterial Meningitis among Intracranial Surgery Patients at a University Hospital in Northern India. Indian J Crit Care Med 2022; 26 (12):1244-1252.

DOI: 10.5005/jp-journals-10071-24363

License: CC BY-NC 4.0

Published Online: 08-12-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Abstract

Background: Cerebrospinal infections are the cause of poor prognosis among post-neurosurgery patients owing to delay in improvement of neurological functions, leading to increased length of hospital stay, proceeding to disability or death. Methods and materials: This retrospective observational study was performed at a tertiary care center in Northern India, where all patients with bacterial cerebrospinal infections from July 2019 to July 2022 were evaluated for post-neurosurgery cerebrospinal shunt infections, and all demographic data and risk factors were extracted from the hospital information system (HIS). Results: The study includes 150 (150/1986, 7.55%) culture-confirmed cases of bacterial meningitis out of 1986 cases of suspected bacterial meningitis patients. Ninety-six (96/150, 64.0%) post-neurosurgery patients with cerebrospinal fluid (CSF) leaks were managed using external ventricular drain (EVD) or ventriculo-peritoneal (VP) shunt. Seventy-four (74/96, 77.08%) patients were managed only on EVD, whereas 22 (22/96, 22.92%) patients were managed only on VP shunt. Eighty-two (82/96, 85.4%) multidrug-resistant microorganisms (MDROs)were isolated and 70 (70/82, 85.36%) were Gram-negative bacteria, of which 56 (56/74, 75.68%) Gram-negative bacteria showed extended-spectrum beta-lactamase (ESBL)-producing character in those with an EVD, 14 (14/22, 63.63%) with a VP shunt. Among Gram-negative bacteria, Acinetobacter baumannii showed high rates of resistance: 21 (21/23, 91.30%) and 8 (8/8, 100%) were ESBL-producing A. baumannii in patients managed on EVD and VP shunt, respectively. Conclusion: This study determines the risk factors, the spectrum of pathogenic microorganisms, multidrug resistance, and the nature of intracranial lesions isolated among the patients who developed bacterial cerebrospinal infections in post-neurosurgery patients.

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  1. Reichert MC, Medeiros EA, Ferraz FA. Hospital-acquired meningitis in patients undergoing craniotomy: Incidence, evolution, and risk factors. Am J Infect Control 2002;30(3):158–164. DOI: 10.1067/mic.2002.119925.
  2. Federico G, Tumbarello M, Spanu T, Rosell R, Iacoangeli M, Scerrati M, et al. Risk factors and prognostic indicators of bacterial meningitis in a cohort of 3580 post neurosurgical patients. Scand J Infect Dis 2001:33(7):533–537. DOI: 10.1080/00365540110026557.
  3. Korinek AM, Golmard J-L, Elcheick A, Bismuth R, van Effenterre R, Coriat P, et al. Risk factors for neurosurgical site infections after craniotomy: A critical reappraisal of antibiotic prophylaxis on 4,578 patients. Br J Neurosurg 2005;19(2):155–162. DOI: 10.1080/02688690500145639.
  4. Zhou H, Zhang X. Intracranial malignant lesions correlate with the requirement for a long treatment course in a postoperative central nervous system infection. Neuropsychiatr Dis Treat 2014;10: 2071–2077. DOI: 10.2147/NDT.S71836.
  5. Xu G, Zhang F, Chen QX. Analysis of high-risk factors correlated to the associated intracranial infection postcraniotomy. Chin J Clin Neurosurg 2008;13(6):362–364.
  6. National Nosocomial Infections Surveillance System. National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 2004;32(8):470–485. DOI: 10.1016/S0196655304005425.
  7. Srinivas D, Veena Kumari HB, Somanna S, Bhagavatula I, Anandappa CB. The incidence of postoperative meningitis in neurosurgery: An institutional experience. Neurol India 2011;59(2):195–198. DOI: 10.4103/0028-3886.79136.
  8. Wang KW, Chang WN, Huang CR, et al. Post-neurosurgical nosocomial bacterial meningitis in adults: Microbiology, clinical features, and outcomes. J Clin Neurosci 2005;12(6):647–650. DOI: 10.1016/j.jocn.2004.09.017.
  9. Yang ZJ, Zhong HL, Wang ZM, Zhao F, Liu PN. Prevention of postoperative intracranial infection in patients with cerebrospinal fluid rhinorrhea. Chin Med J (Engl) 2011;124(24):4189–4192. PMID: 22340385.
  10. Kourbeti IS, Jacobs AV, Koslow M, Karabetsos D, Holzman RS. Risk factors associated with post craniotomy meningitis. Neurosurgery 2007;60(2):317–325; discussion 325–326. DOI: 10.1227/01.NEU.0000249266.26322.25.
  11. Kurtaran B, Kuscu F, Ulu A. The causes of post-operative meningitis: the comparison of gram-negative and gram-positive pathogens. Turkish Neurosurg 2018;28(4):589–596. DOI: 10.1155/2021/9923015.
  12. Hu Y, He W, Yao D, Dai H. Intrathecal or intraventricular antimicrobial therapy for post-neurosurgical intracranial infection due to multidrug-resistant and extensively drug-resistant gram-negative bacteria: A systematic review and meta-analysis. Int J Antimicrob Agents 2019;54(5):556–561. DOI: 10.1016/j.ijantimicag.2019.08.002.
  13. Saklad M. Grading of patients for surgical procedures. Anesthesia 1941;2:281–284. DOI: 10.1097/00000542-194105000-00004.
  14. Keats AS. The ASA classification of physical status – a recapitulation. Anesthesiology 1978;49(4):233–236. DOI: 10.1097/00000542-197810000-00001.
  15. Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing: Twenty-third informational supplement. Clinical and Laboratory Standards Institute. CLSI document M100-S29. Wayne, PA, USA; 2019.
  16. Blomstedt GC. Infections in neurosurgery: A retrospective study of 1143 patients and 1517 operations. Acta Neurochir (Wien) 1985;78: 81–90.
  17. Patir R, Mahapatra AK, Banerji AK. Risk factors in postoperative neurosurgical infection. A prospective study. Acta Neurochir (Wien) 1992;119(1–4):80–84. DOI: 10.1007/BF01541786.
  18. McClelland S 3rd, Hall WA. Postoperative central nervous system infection: Incidence and associated factors in 2111 neurosurgical procedures. Clin Infect Dis 2007;45(1):55–59. DOI: 10.1086/518580.
  19. Dashti SR, Baharvahdat H, Spetzler RF, Sauvageau E, Chang SW, et al. Operative intracranial infection following craniotomy. Neurosurg Focus 2008;24(6):E10. DOI: 10.3171/FOC/2008/24/6/E10.
  20. Scheithauer S, Bürgel U, Bickenbach J, Häfner H, Haase G, Waitschies B, et al. External ventricular and lumbar drainage-associated meningoventriculitis: Prospective analysis of time-dependent infection rates and risk factor analysis. Infection 2010;38(3):205–209. DOI: 10.1007/s15010-010-0006-3.
  21. Crnich CJ, Safdar N, Maki DG. Infections associated with implanted medical devices. In: Finch RG, Greenwood D, Norrby SR, Whitley RJ (Eds.). Antibiotic and Chemotherapy: Anti-infective Agents and their Use in Therapy. Churchill Livingstone; 2003:575–618.
  22. Hoefnagel D, Dammers R, Laak-Poort T, Avezaat CJ. Risk factors for infections related to external ventricular drainage. Acta Neurochir (Wein) 2008;150(3):209–214. DOI: 10.1007/s00701-007-1458-9.
  23. Atkinson RA, Fikrey L, Vail A, Patel HC. Silver-impregnated external-ventricular-drain-related cerebrospinal fluid infections: A meta-analysis. J Hosp Infect 2016;92(3):263–272. DOI: 10.1016/j.jhin.2015.09.014.
  24. Chen C, Zhang B, Yu S, Sun F, Ruan Q, Zhang W, et al. The incidence and risk factors of meningitis after major craniotomy in China: A retrospective cohort study. PLoS One 2014;9(7):e101961. DOI: 10.1371/journal.pone.0101961.
  25. Khan FY, Abukhattab M, Baager K. Nosocomial post neurosurgical Acinetobacter baumannii meningitis: A retrospective study of six cases admitted to Hamad General Hospital, Qatar. J Hosp Infect 2012:80(2):176–179. DOI: 10.1016/j.jhin.2011.08.021.
  26. Erdem I, Hakan T, Ceran N, Metin F, Akcay SS, Kucukercan M, et al. Clinical features, laboratory data, management and the risk factors that affect the mortality in patients with postoperative meningitis. Neurol India 2008:56(4):433–437. DOI: 10.4103/0028-3886.44629.
  27. Sahu C, Patel SS, Singh A, Yaduvanshi N. A comparative in vitro sensitivity study of “Ceftriaxone–Sulbactam–EDTA” and various antibiotics against Gram-negative bacterial isolates from intensive care unit. Indian J Crit Care Med 2020;24(12):1213–1217. DOI: 10.5005/jp-journals-10071-23573.
  28. Rao K, Rangappa P, Jacob I, Hiremath P. Cerebrospinal fluid lactate as a prognostic indicator in postneurosurgical bacterial meningitis and use of intrathecal colistin. Indian J Crit Care Med 2018;22(4):297–299. DOI: 10.4103/ijccm.IJCCM_418_17.
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