Evaluation of postoperative meningitis: comparison of meningitis caused by acinetobacter spp. and other meningitis

Abstract

AIM:To analyse postoperative meningitis (POM) after craniotomy, and to compare the clinical characteristics, treatment outcomes and mortality rates of POM that were caused by Acinetobacter spp. or other possible causes. MATERIAL and METHODS:In this study, POM cases in our hospital between 2008 and 2016 were retrospectively reviewed. Cases were divided into three groups; Acinetobacter spp. meningitis (case group), non-Acinetobacter bacterial meningitis (control group 1) and culture negative meningitis (control group 2). Demographic, clinical, laboratory features, treatment modalities and mortality rates were compared between case and control groups. RESULTS:A total of 112 patients with POM were included in the study. Cerebrospinal fluid (CSF) culture results were negative in 50 (44.6%) patients; bacteria were isolated from CSF of 62 (55.3%) patients. Acinetobacter spp. was isolated from 28 (45%) patients, while bacteria other than Acinetobacter spp. were detected in 34 (55%) patients. No significant differences were observed between case and control groups in terms of age, gender, comorbidity and operation type. For the case group, change of treatment according to culture result was significantly different from control groups (p<0.001).Mortality was 55.6% in the case group, 24.2% in control group 1 (p=0.013), and 24% in control group 2 (p=0.006). In multivariate analysis, isolation of Acinetobacter spp. from CSF culture [OR adj 5.2, 95% confidence interval (CI):1.2-22.0, p=0.026] and inappropriate treatment (OR adj 15.7, 95%CI:3.6-68.9, p<0.001) were determined to be independent risk factors for mortality. CONCLUSION:Postoperative meningitis, especially caused by Acinetobacter spp., and its inappropriate empirical treatment are associated with high mortality.

Etiology and Outcomes of Healthcare-Associated Meningitis and Ventriculitis—A Single Center Cohort Study

“…In our study, overall mortality rate was 16.3%, which is in the range of previous reports [ 2 , 12 , 24 , 26 ]. However, Gram-negative HCAMV was associated with worse clinical outcomes.…”

“…MDR A. baumannii , P. aeruginosa and staphylococci were the most common causes of HCAMV in our cohort. The changing etiology with predominance of Gram-negative bacteria has already been reported in some countries [ 4 , 13 , 24 , 25 ]. Better adherence to antibiotic prophylaxis directed against Gram-positive bacteria and rising prevalence of MDR Gram-negative bacteria in hospitals contribute to this shift.…”

“…However, Gram-negative HCAMV was associated with worse clinical outcomes. Several studies from centers with high prevalence of MDR HCAMV showed significantly higher mortality in these patients [ 2 , 24 , 27 ]. Senturk G.C.…”

Current Perspectives on the Diagnosis and Management of Healthcare-Associated Ventriculitis and Meningitis

“…35,[188][189][190] Of interest, mortality following postoperative VM in a DTR setting was independently associated with the isolation of A. baumannii and the administration of inappropriate empirical treatment. 17 In a cohort of patients with intracranial hemorrhage, the development of VM presented an additional and independent factor that further worsened their prognosis. 191,192 VM patients compared with non-VM individuals had higher mortality and doubled both the hospital length of stay (median stay of 31 vs 16 days) and cost of care.…”

“…1,15 This emergence of difficult-to-treatresistant GN pathogens 16 can lead to inappropriate, discordant antibiotic treatment which may adversely affect the outcome. 17 The literature search shows a lack of standardized diagnostic and treatment protocols as neurosurgical centers deal with variable pathologies, local flora, and infection control policies. Therefore, they can hardly perform high-quality, multi-center, controlled studies, and the available recommendations are based on weak evidence and heterogeneous reports.…”