title: Risk factors associated with postcraniotomy meningitis.
abstract: OBJECTIVE
  The authors conducted a retrospective cohort study to determine the incidence, bacteriological features, and risk factors for postcraniotomy meningitis.
  
  
  METHODS
  Patients older than 18 years who underwent nonstereotactic craniotomies between January 1996 and March 2000 and who survived for more than 7 days were included. Operations for placement of burr holes and shunts were excluded. Records of the first 30 postoperative days were abstracted. Host factors, types of craniotomy, and pre- and postoperative variables were evaluated as risk factors for meningitis
  
  
  RESULTS
  Among 453 patients, there were 25 cases of meningitis. Eight out of 12 culture-positive cases were the result of gram-positive cocci. Four hundred twenty (92%) patients received antibiotic prophylaxis, most commonly a first-generation cephalosporin. In multivariate analysis, the risk of meningitis was increased by surgery that entered a sinus (odds ratio [OR], 4.49; P = 0.018), an increase in the American Society of Anesthesiologists score (OR, 1.72; P = 0.023), and increases in the number of days of external ventricular drainage (OR, 1.21; P = 0.049) and intracranial pressure monitoring (OR, 1.24; P = 0.002).
  
  
  CONCLUSIONS
  Access of upper airway bacteria to the surgical wound, host factors as expressed by the American Society of Anesthesiologists score, and duration of device-related postoperative communication of the cerebrospinal fluid and the environment are major risk factors for postoperative meningitis after craniotomy.
authors.affiliation: Department of Internal Medicine, University Hospital of Crete and Graduate Program Medical School, University of Crete, Voutes, Heraklion, Greece.
authors.forename: Irene S
authors.initials: IS
authors.lastname: Kourbeti
authors.forename: Anke V
authors.initials: AV
authors.lastname: Jacobs
authors.forename: Maxim
authors.initials: M
authors.lastname: Koslow
authors.forename: Dimitris
authors.initials: D
authors.lastname: Karabetsos
authors.forename: Robert S
authors.initials: RS
authors.lastname: Holzman
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003399:Craniotomy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D016920:Meningitis, Bacterial / Q000453:epidemiology* / Q000209:etiology* / Q000517:prevention & control; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000150:complications / Q000453:epidemiology / Q000517:prevention & control