title: Intrathecal or intraventricular therapy for post-neurosurgical Gram-negative meningitis: matched cohort study.
abstract: Gram-negative post-operative meningitis due to carbapenem-resistant bacteria (CR-GNPOM) is a dire complication of neurosurgical procedures. We performed a nested propensity-matched historical cohort study aimed at examining the possible benefit of intrathecal or intraventricular (IT/IV) antibiotic treatment for CR-GNPOM. We included consecutive adults with GNPOM in two centres between 2005 and 2014. Patients receiving combined systemic and IT/IV treatment were matched to patients receiving systemic treatment only. Matching was done based on the propensity of the patients to receive IT/IV treatment. We compared patient groups with 30-day mortality defined as the primary outcome. The cohort included 95 patients with GNPOM. Of them, 37 received IT/IV therapy in addition to systemic treatment (22 with colistin and 15 with amikacin), mostly as initial therapy, through indwelling cerebrospinal fluid drains. Variables associated with IT/IV therapy in the propensity score included no previous neurosurgery, time from admission to meningitis, presence of a urinary catheter and GNPOM caused by carbapenem-resistant Gram-negative bacteria. Following propensity matching, 23 patients given IT/IV therapy and 27 controls were analysed. Mortality was significantly lower with IT/IV therapy: 2/23 (8.7%) versus 9/27 (33.3%), propensity-adjusted OR 0.19, 95% CI 0.04-0.99. Death or neurological deterioration at 30 days, 14-day and in-hospital mortality were lower with IT/IV therapy (OR <0.4 for all) without statistically significant differences. Among patients discharged alive, those receiving IT/IV therapy did not experience more neurological deterioration. Serious adverse events with IT/IV therapy were not documented. Our results support the early use of IT antibiotic treatment for CR-GNPOM when a delivery method is available.
authors.affiliation: Department of Neurosurgery, Tel-Aviv Medical Centre, Tel-Aviv, Israel. Electronic address: shoftyben@gmail.com.
authors.forename: B
authors.initials: B
authors.lastname: Shofty
authors.affiliation: Division of Infectious Diseases, Israel; Internal Medicine B, Rambam Health Care Campus, Haifa, Israel; Rappaport Faculty of Medicine, Technion, Haifa, Israel.
authors.forename: A
authors.initials: A
authors.lastname: Neuberger
authors.affiliation: Rappaport Faculty of Medicine, Technion, Haifa, Israel; Internal Medicine H, Rambam Health Care Campus, Haifa, Israel.
authors.forename: M E
authors.initials: ME
authors.lastname: Naffaa
authors.affiliation: Rappaport Faculty of Medicine, Technion, Haifa, Israel.
authors.forename: T
authors.initials: T
authors.lastname: Binawi
authors.affiliation: Medicine E, Israel.
authors.forename: T
authors.initials: T
authors.lastname: Babitch
authors.affiliation: Neurosurgery, Rabin Medical Centre, Beilinson Hospital, Petah-Tikva, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Israel.
authors.forename: Z H
authors.initials: ZH
authors.lastname: Rappaport
authors.affiliation: Rappaport Faculty of Medicine, Technion, Haifa, Israel; Department of Neurosurgery, Rambam Health Care Campus, Haifa, Israel.
authors.forename: M
authors.initials: M
authors.lastname: Zaaroor
authors.affiliation: Rappaport Faculty of Medicine, Technion, Haifa, Israel; Department of Neurosurgery, Rambam Health Care Campus, Haifa, Israel.
authors.forename: G
authors.initials: G
authors.lastname: Sviri
authors.affiliation: Division of Infectious Diseases, Israel; Rappaport Faculty of Medicine, Technion, Haifa, Israel.
authors.forename: M
authors.initials: M
authors.lastname: Paul
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000009:adverse effects; D015331:Cohort Studies; D064420:Drug-Related Side Effects and Adverse Reactions; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy; D006801:Humans; D007262:Infusions, Intravenous; D057967:Infusions, Intraventricular; D007278:Injections, Spinal / Q000009:adverse effects; D008297:Male; D008581:Meningitis / Q000188:drug therapy* / Q000401:mortality; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D013530:Surgical Wound Infection / Q000188:drug therapy* / Q000401:mortality; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: Gram-negative; intrathecal; intraventricular; meningitis; neurosurgery