Healthcare-Associated Ventriculitis and Meningitis: A Retrospective Analysis

Abstract

Background and objectiveHealthcare-associated ventriculitis and meningitis (HAVM) is frequent in neurocritical patients and associated with significant mortality. Surgery and intracranial devices are usually necessary and may lead to infection. Classical clinical signs and cerebral spinal fluid (CSF) analysis may be unreliable. The purpose of this study was to characterize the prevalence of HAVM, risk factors, and interventions in the neurocritical population admitted in the ICU. MethodsThis was a retrospective single-center analysis of all adult neurocritical patients admitted to an ICU during a three-year period. ResultsA total of 218 neurocritical patients were included. The prevalence of HAVM was 13% and it was found to be associated with mortality. When suspected, it was not possible to exclude HAVM in 30% of the patients. HAVM was significantly associated with surgery, surgical reintervention, and brain devices. Sustained fever was the most frequent clinical sign, and it was significantly associated with unexcluded HAVM. CSF cell count was significantly higher in HAVM, though without microbiological isolation in most of the cases. ConclusionBrain damage, interventions, and devices may significantly alter cerebral homeostasis. Sustained fever is very frequent and may be attributed to several conditions. CSF cell count is useful for the diagnosis of HAVM. HAVM is a clinical challenge in the management of neurocritical patients with important therapeutic and prognostic implications.

Community-Acquired Meningitis Complicated With Pyogenic Ventriculitis and Hydrocephalus in a Patient With Haematological Malignancy: A Case Report and Literature Review

“…High mortality in cases of bacterial meningitis-related hydrocephalus is primarily attributable to elevated intracranial pressure, leading to cerebral herniation. Communicating hydrocephalus is more common than obstructive hydrocephalus, with the former resulting from impaired CSF absorption through arachnoid villi and the latter developing gradually due to inadequate treatment, leading to the obstruction of the foramina of Luschka and Magendie [ 5 ]. Overall, immunocompromised conditions represent the primary risk factor for bacterial invasion of the CNS [ 6 ].…”

“…Each of these complications has specific radiological signs on imaging and requires more extensive treatment than uncomplicated meningitis. Given the possible debilitating outcomes, meningitis and its complications require a high degree of suspicion for diagnosis and prompt initiation of treatment to improve the outcomes and decrease the high risk of mortality [1][2][3][4][5]. Meningitis risk factors include extremes of age, alcohol use disorder, malignancy, splenectomy, and diabetes mellitus [6,7].…”

Healthcare-associated central nervous system infections

“…Healthcare-associated CNS infections usually occur in neurosurgical patients with implanted invasive devices (CSF shunts, CSF drains, lumbar catheters, intrathecal drug infusion pumps, deep brain stimulation devices), recent craniotomy, head or spine trauma or lumbar punctures [5,6 ]. These risk factors facilitate the entrance of microorganisms into the CNS, usually into the CSF.…”