Infections in patients undergoing craniotomy: risk factors associated with post-craniotomy meningitis

Abstract

OBJECT The authors performed a prospective study to define the prevalence and microbiological characteristics of infections in patients undergoing craniotomy and to clarify the risk factors for post-craniotomy meningitis. METHODS Patients older than 18 years who underwent nonstereotactic craniotomies between January 2006 and December 2008 were included. Demographic, clinical, laboratory, and microbiological data were systemically recorded. Patient characteristics, craniotomy type, and pre- and postoperative variables were evaluated as risk factors for meningitis RESULTS Three hundred thirty-four procedures were analyzed (65.6% involving male patients). Traumatic brain injury was the most common reason for craniotomy. Almost 40% of the patients developed at least 1 infection. Ventilatorassociated pneumonia (VAP) was the most common infection recorded (22.5%) and Acinetobacter spp. were isolated in 44% of the cases. Meningitis was encountered in 16 procedures (4.8%), and CSF cultures were positive for microbial growth in 100% of these cases. Gram-negative pathogens (Acinetobacter spp., Klebsiella spp., Pseudomonas aeruginosa, Enterobacter cloaceae, Proteus mirabilis) represented 88% of the pathogens. Acinetobacter and Klebsiella spp. demonstrated a high percentage of resistance in several antibiotic classes. In multivariate analysis, the risk for meningitis was independently associated with perioperative steroid use (OR 11.55, p = 0.005), CSF leak (OR 48.03, p < 0.001), and ventricular drainage (OR 70.52, p < 0.001). CONCLUSIONS Device-related postoperative communication between the CSF and the environment, CSF leak, and perioperative steroid use were defined as risk factors for meningitis in this study. Ventilator-associated pneumonia was the most common infection overall. The offending pathogens presented a high level of resistance to several antibiotics.

The neurosurgical wound and factors that can affect cosmetic, functional, and neurological outcomes

“…Protein energy malnutrition can impair the proliferation of CD8 T lymphocytes responsible for suppressing infection . In the neurosurgical patient, a superficial wound infection can have potentially catastrophic complications, such as meningitis . There is strong evidence that the level of caloric intake can affect the patient's final neurological outcome .…”

“…52 In the neurosurgical patient, a superficial wound infection can have potentially catastrophic complications, such as meningitis. 53 There is strong evidence that the level of caloric intake can affect the patient's final neurological outcome. 54,55 Prolonged protein malnutrition causes the catabolism of muscle fibres, leading to muscle atrophy and subsequent decreased strength.…”

Experimental research on preventing mechanical phlebitis arising from indwelling needles in intravenous therapy by external application of mirabilite

“…Mirabilite is a type of crystalline solid made from the sulfate mineral of the mirabilite family, mainly comprising hydrous sodium sulfate (Na 2 SO 4 10H 2 O). In the theory of traditional Chinese medicine, it is believed that mirabilite is bitter (6). Pharmacopeia of the People's Republic of China (7), edition 2010 states that mirabilite is mainly used to treat abdominal distension, dry stool.…”

2017 Infectious Diseases Society of America’s Clinical Practice Guidelines for Healthcare-Associated Ventriculitis and Meningitis*

“…Also, they are at increased risk of developing infection because of the risk associated with surgery (including surgery after head trauma), direct contamination of the central nervous system (CNS), and the increased risk of meningitis in patients with a CSF leak. In a study of 334 procedures in patients undergoing craniotomy, risk factors associated with post-craniotomy meningitis were use of CSF drain, CSF leak, and perioperative steroid use [32]. Healthcare-associated ventriculitis and meningitis is a problem at medical facilities that perform neurosurgery.…”