Hospital-acquired meningitis in patients undergoing craniotomy: incidence, evolution, and risk factors.
OBJECTIVE
To establish the incidence of postcraniotomy meningitis, identify etiologic agents, assess patients' medical progress in relation to both length of hospitalization and mortality, and analyze risk factors.


METHODS
This study was developed at Hospital São Paulo, a tertiary university hospital, between August 1995 and January 1998. We conducted a case-control trial, in which 50 pairs of patients were matched.


RESULTS
An 8.9%-postcraniotomy meningitis incidence was found. Gram-negative bacilli were the most common etiologic agents isolated. Mortality among the patients was 30%. Mean hospital stay for the patients was 42.9 +/- 22.1 days; for the controls, mean hospital stay was 19.0 +/- 11.4 days (P =.00001). Although several risk factors were identified by univariate analysis, including postoperative external ventricular shunt (OR = 2.92, CI 95% = 1.245-6.865, P =.014), remote site infection (OR = 2.85, CI 95% = 0.995-8.173, P =.051), and repeat operation (OR = 5.02, CI 95% = 1.569-16.066, P =.007), only repeat operation remained in the multivariate analysis model (OR = 3.68, CI 95% = 1.158-11.700, P =.027).


CONCLUSIONS
Postcraniotomy meningitis resulted in a high mortality rate and a longer hospital stay, with repeat operation identified among the risk factors.
Reichert
Magaly Cecília Franchini
MC
Federal University of São Paulo, Escola Paulista de Medicina, Brazil.
Medeiros
Eduardo Alexandrino Servolo
EA
Ferraz
Fernando Antonio Patriani
FA
D001938:Brazil; D016022:Case-Control Studies; D003399:Craniotomy / Q000009:adverse effects*; D003428:Cross Infection / Q000209:etiology*; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000209:etiology; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008581:Meningitis / Q000209:etiology*; D012086:Reoperation; D012307:Risk Factors