title: Risk factors associated with postcraniotomy meningitis: A retrospective study.
abstract: Postcraniotomy meningitis (PCM) is a major challenge in neurosurgery, and changing patterns of infectious agents in PCM have been noted. The limited epidemiological data and urgent clinical needs motivated this research. We conducted this study to determine a risk assessment for PCM and the current pattern of infectious agents.We performed a retrospective case-control study of significant cases of postcraniotomy meningitis in the Changhua Christian Hospital System between January 1, 2008, and December 31, 2012. Postcraniotomy meningitis was diagnosed in 22 out of 4392 surgical patients; this data was reviewed for risk assessment.This study assessed the risk factors for postcraniotomy meningitis and found that it was more frequently seen in patients who were elderly (OR = 1.57, 95% CI = 1.32-2.98, P = 0.013), underwent emergency procedures (OR = 4.82, 95% CI = 1.50-14.53, P = 0.008), had leak of cerebrospinal fluid (OR = 4.62, 95% CI = 2.03-10.50, P = 0.012), had external ventricular drainage (OR = 4.68, 95% CI = 2.46-8.87, P = 0.006), were admitted to the intensive care unit (OR = 2.41, 95% CI = 1.53-8.08, P = 0.012), had used drain placement >72 hours (OR = 2.66, 95% CI = 1.04-4.29, P = 0.007), had surgery >4.5 hours (OR = 2.38, 95% CI = 1.39-4.05, P = 0.005), had repeat operations (OR = 2.74, 95% CI = 1.31-5.73, P = 0.018), endured trauma (OR = 5.97, 95% CI = 1.57-17.61, P = 0.007), or had 30-days mortality (OR = 5.07, 95% CI = 2.20-11.48, P = 0.001). The predominant pathogens isolated from cerebrospinal fluid were Staphylococcus aureus in 8 patients (36.7%) and Acinetobacter baumannii in 7 patients (31.8%). In our study, the mortality rate was 5.1% among all postcraniotomy patients.Accurate risk assessment, early diagnosis, and choice of appropriate antibiotics in accordance with epidemiologic information are the cornerstones of reducing mortality and morbidity in PCM. The changing pattern of infectious agents in PCM over time suggests the necessity of further studies to provide the most up-to-date insight to physicians.
authors: Division of Infectious Disease, Department of Internal Medicine Infection Control Committee Department of Medical Imaging Epidemiology and Biostatistics Center Department of Neurosurgery Division of Critical Care Medicine Changhua Christian Hospital, Changhua Department of Nursing, College of Medicine and Nursing, Hung Kuang University, Taichung County, Taiwan.
authors: Chang-Hua
authors: CH
authors: Chen
authors: Chih-Yen
authors: CY
authors: Chang
authors: Li-Jhen
authors: LJ
authors: Lin
authors: Wei Liang
authors: WL
authors: Chen
authors: Yu-Jun
authors: YJ
authors: Chang
authors: Shu-Hui
authors: SH
authors: Wang
authors: Chun-Yuan
authors: CY
authors: Cheng
authors: Hua-Cheng
authors: HC
authors: Yen
mesh_terms: D040981:Acinetobacter baumannii / Q000302:isolation & purification; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016022:Case-Control Studies; D002681:China; D016001:Confidence Intervals; D003399:Craniotomy / Q000009:adverse effects* / Q000379:methods; D003422:Critical Care / Q000379:methods; D004322:Drainage / Q000379:methods; D005260:Female; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D008297:Male; D016920:Meningitis, Bacterial / Q000209:etiology* / Q000401:mortality* / Q000628:therapy; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods; D011183:Postoperative Complications / Q000175:diagnosis / Q000401:mortality; D011379:Prognosis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013211:Staphylococcus aureus / Q000302:isolation & purification; D016019:Survival Analysis
chemical_list: D000900:Anti-Bacterial Agents