Neurosurgical Meningitis: Clinico-Microbiological Profile and Treatment Outcome from a Tertiary Care Center in India

Abstract

Background?Meningitis following neurosurgical procedure is a well-recognized and potentially fatal complication. The Indian literature on microbiological epidemiology is scarce. The aim of our study was to know clinical, microbiological profile and treatment outcomes of patients with neurosurgical meningitis at our center. Methods?This was a retrospective observational cohort study of 25 culture-proven neurosurgical meningitis cases performed at the Apollo Speciality Hospital, Chennai, India, between January 2009 and May 2012. Results?In our study, nine patients had skull fracture and cerebrospinal fluid leak, nearly 50% of the patients underwent craniotomy, and five patients had endoscopic surgery while 64% of the patients required shunt placement or drains. Only nine patients (36%) had definite clinical signs of meningitis and mean duration of onset of symptoms from surgery was 11.12 days. A total of 18 patients (72%) had gram-negative bacterial meningitis and majority (83.3%) was due to carbapenem-resistant organisms. Predominant isolate was Pseudomonas aeruginosa (44.4%), and the second most common isolate was Acinetobacter baumannii (33.3%). Among cases of gram-negative bacterial meningitis, patients who had carbapenem-resistant isolates were given combination antimicrobials (carbapenem/cefepime tazobactam with colistin/gentamicin) as per susceptibility via intravenous and intrathecal through the drain (extraventricular or lumbar). Only five patients (27.7%) had a complete cure. Conclusion?Gram-negative organisms, mainly Pseudomonas and Acinetobacter, are predominant pathogen in neurosurgical meningitis in our center. While treating multidrug-resistant gram-negative meningitis, device removal and a combination of antimicrobial agents via both intravenous and intraventricular routes are crucial to achieve cure.