Epidemiology of patients with central nervous system infections, mainly neurosurgical patients: a retrospective study from 2012 to 2019 in a teaching hospital in China

Abstract

Background Central nervous system (CNS) infections are relatively rare but are associated with high mortality worldwide. Empirical antimicrobial therapy is crucial for the survival of patients with CNS infections, and should be based on the knowledge of the pathogen distribution and antibiotic sensitivities. The aim of this study was to investigate the features of pathogens in patients with CNS infections in North China and evaluate the risk factors for mortality and multi-drug-resistant (MDR) bacterial infections. Methods A retrospective study was conducted with patients with positive cerebrospinal fluid (CSF) cultures in a teaching hospital from January 2012 to December 2019. The following data were collected: demographic characteristics, laboratory data, causative organisms and antimicrobial sensitivity results. Data were analyzed with SPSS 16.0. Univariate analysis and binary logistic regression analyses were performed to identify the risk factors for mortality and MDR bacterial infections. Results A total of 72 patients were diagnosed with CNS infections, and 86 isolates were identified. The proportions of Gram-positive bacteria, Gram-negative bacteria and fungi were 59.3, 30.2 and 10.5%, respectively. The predominant Gram-positive bacteria was Coagulase-negative Staphylococci. Acinetobacter baumannii, Escherichia coli and Klebsiella spp. were the predominant Gram-negative bacteria. Compared to 2012–2015 years, the proportion of Gram-negative bacteria increased markedly during 2016–2019 years. Coagulase-negative Staphylococci, Streptococcus pneumoniae and Enterococcus faecium had 100% sensitivity to vancomycin, teicoplanin and linezolid. Acinetobacter baumannii and Klebsiella pneumoniae were 100% sensitive to tigecycline. Escherichia coli had 100% sensitivity to amikacin, meropenem and imipenem. The overall mortality rate in the 72 patients was 30.6%. In multivariate analysis, age > 50 years, pulmonary infections and CSF glucose level < the normal value were associated with poor outcomes. CSF adenosine deaminase level > the normal value and the presence of external ventricular drainage/lumbar cistern drainage were associated with MDR bacterial infections. Conclusions The mortality rate due to CNS infections reached 30.6% in our study. The proportion of Gram-negative bacteria has increased markedly in recent years. We should give particular attention to patients with risk factors for mortality and MDR bacterial infections mentioned above.

Epidemiological and clinical characteristics of central nervous system infections in a tertiary center: A retrospective study

“…This finding is consistent with another observational study conducted in Malaysia where tuberculous meningitis was not only the most diagnosed CNS infection, but also a cause of significant mortality and morbidity among the patients 5 . The male: female ratio in our study was 1.43:1 which is in line with the finding of a study done in China 12 (3:1) but in contrast to the global data obtained from a comprehensive meta‐analysis (1:1.74) 1 . Almost half of the patients were from Province 3 (Bagmati), and the location of our institution in the same province explains this data.…”

Exploring epigenetic reprogramming during central nervous system infection

“…Collectively, these findings suggest that aging microglia are hyperinflammatory, both at baseline and in response to bacterial stimuli due, in part, to changing methylation landscapes. This is an epigenetic phenomenon that could play a key role in explaining increased CNS infection susceptibility and poor outcomes in the elderly 42 . An ongoing clinical analysis in our laboratory appears to agree with this possibility, where increased age was associated with a greater‐than‐average risk of surgical‐site infection following a craniotomy neurosurgical intervention (unpublished data).…”

“…This is an epigenetic phenomenon that could play a key role in explaining increased CNS infection susceptibility and poor outcomes in the elderly. 42 An ongoing clinical analysis in our laboratory appears to agree with this possibility, where increased age was associated with a greater‐than‐average risk of surgical‐site infection following a craniotomy neurosurgical intervention (unpublished data). This association is correlative at present, but skewed microglial epigenetic regulation may represent an important factor for promoting CNS infection risk in aging populations.…”

Risk factors for 90-day all-cause mortality in post-operative central nervous system infections (PCNSIs): A retrospective study of 99 patients in China

“…Shi et al and Zhang et al reported that age > 50 years, MV, ICU admission, pulmonary infections, and GCS score ≤ 8 were risk factors for increased mortality, whereas CSF information, operative data, and mNGS testing were not evaluated in their studies. [ 13 , 14 ] Our study revealed that in addition to GCS score, MV, and age, C/B-Glu ≤ 0.23, a total number of operations larger than 2 and non-mNGS test were also risk factors for mortality. In the Cox proportional hazards analysis, we found that MV and poor wound healing were significant risk factors for mortality.…”