title: Clinical Characteristics and Predictors of Adverse Outcome in Adult and Pediatric Patients With Healthcare-Associated Ventriculitis and Meningitis.
abstract: Background.  Healthcare-associated meningitis or ventriculitis is a serious and life-threatening complication of invasive neurosurgical procedures or penetrating head trauma. Methods.  We performed a retrospective study of adults and children with the diagnosis of healthcare-associated meningitis or ventriculitis, as defined by the 2015 Centers of Disease Control and Prevention case definition, at 2 large tertiary care hospitals in Houston, Texas from July 2003 to November 2014. Patients were identified by infection control practitioners and by screening cerebrospinal fluid samples sent to the central laboratory. We collected data on demographics, clinical presentations, laboratory results, imaging studies, treatments, and outcomes. Results.  A total of 215 patients were included (166 adults and 49 children). A positive cerebrospinal fluid culture was seen in 106 (49%) patients, with the majority of the etiologies being Staphylococcus and Gram-negative rods. An adverse clinical outcome was seen in 167 patients (77.7%) and was defined as death in 20 patients (9.3%), persistent vegetative state in 31 patients (14.4%), severe disability in 77 patients (35.8%), or moderate disability in 39 patients (18.1%). On logistic regression analysis, age >45 years (adjusted odds ratio [OR], 6.47; 95% confidence interval [CI], 2.31-18.11; P ≤ .001), abnormal neurological exam (adjusted OR, 3.04; 95% CI, 1.27-7.29; P = .013), and mechanical ventilation (adjusted OR, 5.34; 95% CI, 1.51-18.92; P = .01) were associated with an adverse outcome. Conclusions.  Healthcare-associated meningitis or ventriculitis is associated with significant morbidity and mortality.
authors.affiliation: Department of Internal Medicine , University of Texas Health Science Center at Houston.
authors.forename: Chanunya
authors.initials: C
authors.lastname: Srihawan
authors.affiliation: Department of Internal Medicine , University of Texas Health Science Center at Houston.
authors.forename: Rodrigo Lopez
authors.initials: RL
authors.lastname: Castelblanco
authors.affiliation: Department of Internal Medicine , University of Texas Health Science Center at Houston.
authors.forename: Lucrecia
authors.initials: L
authors.lastname: Salazar
authors.affiliation: Departments of Pediatrics.
authors.forename: Susan H
authors.initials: SH
authors.lastname: Wootton
authors.affiliation: Departments of Pediatrics.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Aguilera
authors.affiliation: Department of Internal Medicine , University of Texas Health Science Center at Houston.
authors.forename: Luis
authors.initials: L
authors.lastname: Ostrosky-Zeichner
authors.affiliation: Neurosurgery; Pediatric Surgery, University of Texas Health.
authors.forename: David I
authors.initials: DI
authors.lastname: Sandberg
authors.affiliation: Neurosurgery; Mischer Neuroscience Institute, Memorial Hermann Hospital, Texas Medical Center, Houston.
authors.forename: HuiMahn A
authors.initials: HA
authors.lastname: Choi
authors.affiliation: Neurosurgery; Mischer Neuroscience Institute, Memorial Hermann Hospital, Texas Medical Center, Houston.
authors.forename: Kiwon
authors.initials: K
authors.lastname: Lee
authors.affiliation: Neurosurgery; Mischer Neuroscience Institute, Memorial Hermann Hospital, Texas Medical Center, Houston.
authors.forename: Ryan
authors.initials: R
authors.lastname: Kitigawa
authors.affiliation: Neurosurgery; Pediatric Surgery, University of Texas Health; Mischer Neuroscience Institute, Memorial Hermann Hospital, Texas Medical Center, Houston.
authors.forename: Nitin
authors.initials: N
authors.lastname: Tandon
authors.affiliation: Department of Internal Medicine , University of Texas Health Science Center at Houston.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Hasbun
keywords: healthcare-associated meningitis; prognosis; risk factors; ventriculitis