Management of post-neurosurgical meningitis: narrative review

Hussein, Khetam; Bitterman, Roni; Shofty, Ben; Paul, Mical; Neuberger, Ami

doi:10.1016/j.cmi.2017.05.013

Cited by 91 publications

(84 citation statements)

References 82 publications

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“…EVDs and ICPs were inserted in the operating room, while most LDs were inserted on the ward at bedside. Meningitis was managed according to published and local guidelines, the latter considering the local epidemiology [13,35].…”

Section: Methodsmentioning

confidence: 99%

Risk factors for meningitis in neurosurgical patients with cerebrospinal fluid drains: prospective observational cohort study

et al. 2019

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Background Cerebrospinal fluid (CSF) drainage or intracranial pressure (ICP) monitoring devices are life-saving devices. We examined the risk factors for infections related to them and assessed the effect of an infection control (IC) intervention. Methods A prospective observational study was conducted in the Neurosurgical Department of our hospital between 2014 and 2017. We included all consecutive patients undergoing CSF catheter insertions, including external ventricular drainage (EVD), lumbar drainage (LD), and ICP catheters. An IC intervention was implemented between March and August 2016. We examined risk factors for meningitis or ventriculitis, defined according to Healthcare-associated infections surveillance definitions, on univariate and multivariate analysis. Results A total of 232 patients with 437 drains (212 EVDs, 92 LDs, and 133 ICPs) were included. On univariate and multivariate analysis, the infection incidence was 13.7 per 1000 drain days (17.3/1000 before IC intervention, 7.9/1000 during, and 9.2/1000 after the intervention). Most episodes were caused by Gram-negative bacteria, and the most common pathogen was Acinetobacter baumanii. Risk factors for infection per patient included diabetes mellitus (p = 0.017), CSF leak (p = 0.032), drain opening (p = 0.027), and the duration of the drain in days (p = 0.035). Risk factors per catheter included drain opening (p < 0.001), drain days (p = 0.001), and the IC intervention period compared to before the intervention period (p = 0.037). When restricting the analysis to EVDs, drain days (p = 0.001) was the only significant risk factor. Conclusions Strict adherence to IC, shortening drain duration, and avoiding unnecessary opening and manipulation of the drains are crucial to preventing neurosurgical drain infections.

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Section: Methodsmentioning

confidence: 99%

Risk factors for meningitis in neurosurgical patients with cerebrospinal fluid drains: prospective observational cohort study

et al. 2019

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“…Generally, as is common in other surgical practice, the risk factor of inserting device infection, the venue of procedure and the surgical technique are know by surgeon's experience. 27 Wound culture were dominated with GPB (71.87%), with isolate was S. aureus (39.13%) and followed GNB P. aeruginosa (55.56%). Negi et.al are found 96,4% surgical site infection yielding bacteria growth with S. aureus (54.4%), P. aeruginosa (21.7%) and E. coli.…”

mentioning

confidence: 95%

Microbial Pattern and Antibiotic Susceptibility in Pediatric Intensive Care Unit Dr. Soetomo Hospital, Surabaya

A.A.W.

Irwanto

Dharmawati

et al. 2019

IJTID

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Gram-negative bacterial are known as common pathogen caused infection in Pediatric Intensive Care Unit (PICU). Microbial Pattern and Antibiotic Susceptibility are needed as clinical data for selected appropriate antibiotic therapy. In PICU Dr. Soetomo hospital until now still lacking of Microbial Pattern and Antibiotic Susceptibility data. This descriptive study is to recognized Microbial Pattern and Antibiotic Susceptibility in PICU patients from blood, urine, sputum, stool, cerebrospinal fluid, endotracheal tube, pus swab and pleural fluid culture specimens. Patients whose admitted into PICU without signs of infections were excluded from the study. The inclusion criteria are patients with sign infection as follows: fever < 36,5°C or > 37.5°C, leukocyte < 4000/mm 3 or > 10000/mm 3 , marker infections CRP >10 mg/L or PCT >0,3 ng/mL, bradycardia or tachycardia, tachypnea, infiltrates on chest X-ray, turbid urine, dysuria, thrombophlebitis, abdominal pain or tenderness, and mucous or skin lesion. Medical record data from 2011 to 2016, revealed 1138 patients had positive microbial culture result, wherein positive result came from blood 44.46%, urine 19.15%, sputum 11.59%, stool 8.96%, cerebrospinal fluid 7.50%, endotracheal tube 4.04%, pus swab 2.89%, and pleural fluid 1.41%. The microorganisms found in PICU Dr. Soetomo was dominated with gram negative bacteria. Commonest bacterial that recognized from blood was B. cepacea, urine was E. coli, sputum was P. aeruginosa, Stool was E. coli, Cerebrospinal fluid was S. cohnii, endotracheal tube was K. pneumoniae ESBL, pus swab was S. aureus, and pleural fluid was S. maltophilia. Both gram-negative bacteria and gram-positive bacteria isolates revealed multiple drug resistance to commonly used antibiotic, but still had good susceptibility for antibiotic such as; amikacin, cefoperazone-sulbactam, linezolid, vancomycin and carbapenem group. ABSTRAKBakteri gram negatif merupakan patogen tersering penyebab infeksi di ruang rawat intensif anak. Pola bakteri dan kepekaan antibiotik diperlukan sebagai data klinis dalam pemilihan terapi antibiotik yang sesuai. Di ruang rawat intensif anak RS.Dr. Soetomo hingga saat ini masih sangat kekurangan data mengenai pola bakteri dan kepekaan antibiotik. Penelitian deskriptif ini bertujuan untuk membuat pola bakteri dan kepekaan antibiotika pada pasien yang dirawat di ruang rawat intensif anak dari spesimen darah, urin, sputum, feces, cairan serebrospinal,tabung endotrakeal (ETT), pus luka dan cairan pleura. Pasien yang masuk ke PICU yang tidak menunjukkan tanda dan gejala infeksi di eklusi dari penelitian. Kriteria inklusi pada penelitian ini adalah ditemukannya tanda dan gejala infeksi, antara lain ;demam < 36,5°C or > 37.5°C, kadar leukosit darah < 4000/mm3 or > 10000/mm3, marker infeksi CRP >10 mg/L or PCT >0,3 ng/mL, bradikardi atau takikardi, takipneu, gambaran infiltrate pada radiologi paru,urine yang keruh, nyeri berkemih, tromboplebitis, nyeri perut, dan lesi pada mukosa atau kulit. Dari data rekam medis dari tahun 2011 sampai...

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“…Routine CSF analysis, such as glucose levels, cell counts and protein concentration are retained by most authors as criteria to diagnose PBM 10–12 . In many diagnostic studies in patients with PBM, CSF routine examinations, including WBC and neutrophil counts, protein levels and hypoglycorrhachia, were neither specific nor associated with high positive and negative predictive values 13 . Tamune et al demonstrated that the CSF/blood glucose ratio may predict the presence of bacterial meningitis more precisely than other routinely measured markers in CSF 14 .…”

Section: Discussionmentioning

confidence: 93%

Cerebrospinal Fluid Lactate as an Indicator for Post-Neurosurgical Bacterial Meningitis

Rebai¹,

Ines²,

Aziz³

et al. 2019

Indian Journal of Critical Care Medicine

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Objective To evaluate the interest of cerebrospinal fluid (CSF) lactate assay for the diagnosis of post-neurosurgical bacterial meningitis (PBM). Methods We conducted at our neurosurgical resuscitation unit a prospective study of patients who underwent elective or emergency craniotomy. Lumbar puncture was performed in all patients who had clinical suspicion of PBM for CSF culture and cytological and chemical analysis (glucose, protein, lactate). The diagnosis of PBM is made according to the criteria proposed by the Center for Disease Control and Prevention (CDC). Receiver Operating Characteristic (ROC) was used to determine the diagnostic accuracy of CSF lactate. Results 72 patients were studied and only 32 of them had the clinical and biological criteria of the diagnosis of PBM. Median CSF lactate was 6.18 mmol/L for PBM vs 2.63 mmol/L for no PBM (p < 0.001). CSF lactate may predict the presence PBM, with a AUC of 0.98 and NPV of 99.1. The analysis of Youden's index also confirms the good diagnostic power of CSF lactate with a value of 83 at a cut-off value of 4 mmol/L and a sensitivity of 92.3% and specificity of 91.6%. Conclusion Our study shows that the CSF lactate as an indicator for PBM. It is a fast and simple test that can help the clinician to optimize the management of PBM and decrease premature cessation of antibiotics. How to cite this article Lotfi R, Ines B, et al. Cerebrospinal Fluid Lactate as an Indicator for Post-neurosurgical Bacterial Meningitis. Indian J Crit Care Med 2019;23(3):127-130.

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Management of post-neurosurgical meningitis: narrative review

Abstract: Guiding the optimal management of PNM will necessitate collaborative multicentre efforts and unique study designs.

Cited by 91 publications

References 82 publications

Risk factors for meningitis in neurosurgical patients with cerebrospinal fluid drains: prospective observational cohort study

Risk factors for meningitis in neurosurgical patients with cerebrospinal fluid drains: prospective observational cohort study

Microbial Pattern and Antibiotic Susceptibility in Pediatric Intensive Care Unit Dr. Soetomo Hospital, Surabaya

Cerebrospinal Fluid Lactate as an Indicator for Post-Neurosurgical Bacterial Meningitis

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