Risk factors and prognostic indicators of bacterial meningitis in a cohort of 3580 postneurosurgical patients.
In order to identify the incidence, risk factors and prognostic indicators of postneurosurgical bacterial meningitis, a 9-y retrospective cohort study was performed. The cohort comprised 3580 individuals who underwent neurosurgical operations at the Department of Neurosurgery of Catholic University, Rome, a 1,700-bed university hospital. We observed 52 episodes of postneurosurgical meningitis, with infection rates of 1.4/100 patients, 0.8/100 operations for craniotomies and 2.6/100 operations for internal cerebrospinal fluid (CSF) shunt or ventriculostomy with external drainage. The overall infection rate decreased from 2.5/100 operations in 1989 to 0.9/100 in 1997 (p = 0.03). Logistic regression analysis indicated that duration of ventriculostomy with external drainage [p < 0.01; odds ratio (OR) = 9.67; 95% confidence interval (CI) = 2.44-38.321 and increasing value of the APACHE III score (p <0.01; OR = 8.51; 95% CI = 2.15-33.68) were independent risk factors for development of meningitis. The overall case fatality rate was 8%. Predictors of mortality were low ( < 1.66 mmol/l) CSF glucose concentration (p = 0.001), increasing value of the APACHE IIl score (p = 0.002) and Gram-negative aetiology (p = 0.003).
Federico
G
G
Department of lnfectious Diseases, Catholic University Rome, Italy.
Tumbarello
M
M
Spanu
T
T
Rosell
R
R
Iacoangeli
M
M
Scerrati
M
M
Tacconelli
E
E
D018806:APACHE; D000328:Adult; D015331:Cohort Studies; D003399:Craniotomy / Q000009:adverse effects; D005260:Female; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D016920:Meningitis, Bacterial / Q000175:diagnosis* / Q000209:etiology*; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D016017:Odds Ratio; D011183:Postoperative Complications / Q000175:diagnosis* / Q000209:etiology*; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D014696:Ventriculostomy / Q000009:adverse effects