title: Post-neurosurgical meningitis: Management of cerebrospinal fluid drainage catheters influences the evolution of infection.
abstract: BACKGROUND
  In order to better define the pathogenic role of cerebrospinal fluid (CSF) drainage catheters in postoperative patients, we comparatively analyze the clinical course of device and non-device-related meningitis.
  
  
  METHODS
  This is an observational, partially prospective, study on consecutive adult patients who developed meningitis after undergoing neurosurgical procedures at the Neurosurgery and Neurointensive care Departments, Spedali Civili, Brescia, Italy, between January 1999 and August 2007.
  
  
  RESULTS
  All 77 consecutive post-neurosurgical meningitis events in 65 patients were included in the analysis. Most were classified as external ventricular drainage (EVD)-related meningitis (23 cases, group A), external spinal drainage (ESD)-related meningitis (12 cases, group B), and non-device-related post-neurosurgical meningitis (30 cases, group C). Proven meningitis was identified in 78.3%, 91.7% and 56.7% of the events, respectively. ESD-related meningitis had a shorter onset time vs EVD and non-device-associated meningitis (3 daysversus6 and 7 days, respectively). Median antibiotic treatment duration was 20, 17, and 22.5 days in groups A, B, and C, respectively. Overall, 8 patients (34.8%) in group A, 3 (25.0%) in group B, and 3 (10.0%) in group C died. Median time to become afebrile was shorter in group C than in group A (10 daysversus12 days,P= 0.04). Removal of the device later than 48 hours after meningitis onset, as well as implantation of a second device were associated with a slower time of meningitis resolution.
  
  
  CONCLUSIONS
  Early device removal and avoiding implantation of a second device were associated with short illness duration. Larger studies are warranted to confirm the conclusions of this study.
authors.affiliation: Clinic of Infectious and Tropical Diseases, Spedali Civili Hospital, Brescia, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Soavi
authors.affiliation: Clinic of Infectious and Tropical Diseases, Spedali Civili Hospital, Brescia, Italy.
authors.forename: Manuela
authors.initials: M
authors.lastname: Rosina
authors.affiliation: Department of Neurosurgery, ASST - Ovest Milanese, Legnano, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Stefini
authors.affiliation: Department of Neurosurgery, Spedali Civili Hospital, Brescia, Italy.
authors.forename: Alessia
authors.initials: A
authors.lastname: Fratianni
authors.affiliation: Clinic of Infectious and Tropical Diseases, Spedali Civili Hospital, Brescia, Italy.
authors.forename: Barbara
authors.initials: B
authors.lastname: Cadeo
authors.affiliation: Clinic of Infectious and Tropical Diseases, Spedali Civili Hospital, Brescia, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Magri
authors.affiliation: Department of Anesthesia, Critical Care and Emergency, Spedali Civili Hospital, Brescia, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Latronico
authors.affiliation: Department of Neurosurgery, Spedali Civili Hospital, Brescia, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Fontanella
authors.affiliation: Clinic of Infectious and Tropical Diseases, Spedali Civili Hospital, Brescia, Italy.
authors.forename: Liana
authors.initials: L
authors.lastname: Signorini
keywords: Cerebrospinal fluid drainage catheters; meningitis; neurosurgery