title: Postoperative Central Nervous System Infection After Neurosurgery in a Modernized, Resource-Limited Tertiary Neurosurgical Center in South Asia.
abstract: OBJECTIVE
  Postoperative central nervous system infections (PCNSIs) are rare but serious complications after neurosurgery. The purpose of this study was to examine the prevalence and causative pathogens of PCNSIs at a modernized, resource-limited neurosurgical center in South Asia.
  
  
  METHODS
  A retrospective analysis was conducted of the medical records of all 363 neurosurgical cases performed between June 1, 2012, and June 30, 2013, at a neurosurgical center in South Asia. Data from all operative neurosurgical cases during the 13-month period were included.
  
  
  RESULTS
  Cerebrospinal fluid (CSF) analysis indicated that 71 of the 363 surgical cases had low CSF glucose or CSF leukocytosis. These 71 cases were categorized as PCNSIs. The PCNSIs with positive CSF cultures (9.86%) all had gram-negative bacteria with Pseudomonas aeruginosa (n = 5), Escherichia coli (n = 1), or Klebsiella pneumoniae (n = 1). The data suggest a higher rate of death (P = 0.031), a higher rate of CSF leak (P < 0.001), and a higher rate of cranial procedures (P < 0.001) among the infected patients and a higher rate of CSF leak among the patients with culture-positive infections (P = 0.038).
  
  
  CONCLUSIONS
  This study summarizes the prevalence, causative organism of PCNSI, and antibiotic usage for all of the neurosurgical cases over a 13-month period in a modernized yet resource-limited neurosurgical center located in South Asia. The results from this study highlight the PCNSI landscape in an area of the world that is often underreported in the neurosurgical literature because of the paucity of clinical neurosurgical research undertaken there. This study shows an increasing prevalence of gram-negative organisms in CSF cultures from PCNSIs, which supports a trend in the recent literature of increasing gram-negative bacillary meningitis.
authors.affiliation: Georgetown University School of Medicine, Washington, DC, USA. Electronic address: chidswathi@gmail.com.
authors.forename: Swathi
authors.initials: S
authors.lastname: Chidambaram
authors.affiliation: Department of Neurosurgery, Georgetown University Medical Center, Washington, DC, USA.
authors.forename: M Nathan
authors.initials: MN
authors.lastname: Nair
authors.affiliation: Post Graduate Institute of Neurological Surgery, Dr. A. Lakshmipathi Neurosurgical Centre, Voluntary Health Services Hospital, Chennai, Tamil Nadu, India.
authors.forename: Shyam Sundar
authors.initials: SS
authors.lastname: Krishnan
authors.affiliation: Department of Biostatistics, Bioinformatics and Biomathematics, Georgetown University Medical Center, Washington, DC, USA.
authors.forename: Ling
authors.initials: L
authors.lastname: Cai
authors.affiliation: Department of Biostatistics, Bioinformatics and Biomathematics, Georgetown University Medical Center, Washington, DC, USA.
authors.forename: Weiling
authors.initials: W
authors.lastname: Gu
authors.affiliation: Post Graduate Institute of Neurological Surgery, Dr. A. Lakshmipathi Neurosurgical Centre, Voluntary Health Services Hospital, Chennai, Tamil Nadu, India.
authors.forename: Madabushi Chakravarthy
authors.initials: MC
authors.lastname: Vasudevan
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002494:Central Nervous System Infections / Q000453:epidemiology* / Q000209:etiology*; D002555:Cerebrospinal Fluid / Q000378:metabolism / Q000382:microbiology; D065634:Cerebrospinal Fluid Leak / Q000453:epidemiology / Q000209:etiology; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000453:epidemiology* / Q000209:etiology*; D006295:Health Resources / Q000191:economics; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D016920:Meningitis, Bacterial / Q000209:etiology* / Q000382:microbiology; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D012189:Retrospective Studies; D062606:Tertiary Care Centers / Q000191:economics*
chemical_list: D000900:Anti-Bacterial Agents
keywords: Cost analysis; Infection; Meningitis; Postoperative complications; Resource-limited