Risk Factors Associated With Postcraniotomy Meningitis

Kourbeti, Irene S.; Jacobs, Anke V; Koslow, Maxim; Karabetsos, Dimitris; Holzman, Robert S.

doi:10.1227/01.neu.0000249266.26322.25

Cited by 119 publications

(115 citation statements)

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“…This is very important especially since PCM often presents with subtle symptoms. 14 Our results are largely confirmatory, and no new findings were demonstrated, except for the risk factor of the perioperative steroids, which has not been extensively discussed in the literature before. The description of the pathogens and their resistance profiles might be applicable to our academic center only.…”

Section: Microbiology Of Other Infectionssupporting

confidence: 83%

“…A positivity rate of 32% was reported in another prospective study. 28 Retrospective studies by Kourbeti et al have demonstrated a positivity rate ranging from 50% 14 to 74% (unpublished data). In those studies there were not any differences in the CSF characteristics between culture-positive and culture-negative cases.…”

Section: Meningitismentioning

confidence: 90%

“…This has not been described before in studies regarding PCM and in most studies regarding postoperative wound infections in general neurosurgical patients. 4,5,[12][13][14][15]23,26,28,33 The effect of steroids on patients undergoing neurosurgical procedures has been variably reported. 21 In certain studies, the steroid effect has not been specifically investigated.…”

Section: 23mentioning

confidence: 99%

See 2 more Smart Citations

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

Kourbeti¹,

Vakis²,

Ziakas

et al. 2015

JNS

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132

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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.

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Section: Microbiology Of Other Infectionssupporting

confidence: 83%

Section: Meningitismentioning

confidence: 90%

Section: 23mentioning

confidence: 99%

See 1 more Smart Citation

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

Kourbeti¹,

Vakis²,

Ziakas

et al. 2015

JNS

Self Cite

132

View full text Add to dashboard Cite

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“…It is possible for pathogens to migrate through these devices that provide communication between the CSF and the environment postoperatively. What we do know from the current literature is that postsurgical drainage and ICP monitoring are related to a higher risk of SSI (13,14). However, the efficacy of the antimicrobial prophylaxis, which regimen to use and the duration to use are still controversial (2,22,24).…”

Section: Resultsmentioning

confidence: 99%

Antimicrobial prophylaxis at neurosurgical department of a major hospital in china: compare of cross sectional studies

Yang²,

He³

et al. 2014

Turkish Neurosurgery

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AIm:To compare the effects of post neurosurgical antimicrobial prophylaxis before and after the adoption of a new protocol in our department, which changed from prolonged prophylaxis to limited usage. mATERIAL and mETHods: Two cross-sectional studies were performed to compare the 24-hour antimicrobial use for all the inpatients at the neurosurgical ward 1 day before (June 30, 2011) and 1 year after (June 29, 2012) the beginning of the new rules. Student's t-test or the chisquare test were used to compare baseline characteristics and prophylactic or therapeutic antimicrobial usage between the groups. REsuLTs:The total of 391 patients enrolled consisted of 221 for June 30, 2011 as group 1 and 170 for June 29, 2012 as group 2. The baseline characteristics of the groups showed no significant difference. The prophylactic use significantly decreased in Group 2 (13.1% vs. 5.9%, p=0.018). However, total therapeutic use (10.9% vs. 18.2%, p=0.041) and the use for nosocomial infection (7.32% vs. 15.9%, p=0.009) both increased significantly in Group 2. Furthermore, therapeutic use for surgical site infections also increased significantly (3.16% vs. 9.41%, p=0.015).CoNCLusIoN: Shorter antimicrobial prophylaxis may increase post neurosurgical infection. The optimal duration of neurosurgical antimicrobial prophylaxis should be compliant with local hospital conditions and further prospective trials are required to address this issue on a procedure-specific basis.KEywoRds: Antimicrobial prophylaxis, Neurosurgery, Cross-sectional study ÖZ AmAÇ: Uzun süreli profilaksiden kısıtlı kullanıma geçecek şekilde bölümümüzde yeni bir protokolün kabullenilmesinden önce ve sonra nöroşirürji sonrasında antimikrobiyal profilaksinin etkilerini karşılaştırmak. ,9, p=0,018). Ancak nozokomiyal enfeksiyon için kullanım (%7,32 ve %15,9, p=0,009) ve total terapötik kullanım (%10,9 ve %18,2, p=0,041) değerlerinin her ikisi Grup 2'de önemli ölçüde arttı. Ayrıca, cerrahi bölge enfeksiyonları için terapötik kullanım da önemli ölçüde arttı (%3,16 ve %9,41, p=0,015). soNuÇ: Daha kısa antimikrobiyal profilaksi nöroşirürji sonrası enfeksiyonu artırabilir. Nöroşirürji için antimikrobiyal profilaksinin optimum süresi yerel hastane koşullarına uymalıdır ve bu konuyu spesifik bir temelde ele almak için ek prospektif çalışmalar gereklidir.ANAHTAR sÖZCÜKLER: Antimikrobiyel profilaksi, Nöroşirürji, Çapraz kesit çalışması

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“…CPC, however, is hypervascular and infiltrative, making GTR difficult to achieve. Patients with CPC may therefore require more comprehensive treatment, regardless of the extent of resection (8)(9)(10)(11)(12).Radiotherapy and chemotherapy effectively prolong overall survival times in patients with CPC (10,13,14). Radiotherapy, however, is only suitable for patients >3 years (2) and it remains unclear which patients may benefit from adjuvant therapy based on histological examination alone.…”

mentioning

confidence: 99%

Increased NG2 and SOX2 expression is associated with high-grade choroid plexus tumors

Zhao

Feng

et al. 2017

Oncology Letters

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Abstract. The World Health Organization classification of choroid plexus tumors (CPT) includes three distinct grades:Choroid plexus papilloma (CPP), atypical choroid plexus papilloma (ACPP) and choroid plexus carcinoma (CPC). The molecular basis for these pathological distinctions may help to stratify tumors and provide an insight into the clinical behavior of CPTs. In the present study, the progenitor and stem cell markers neuron glia antigen-2 (NG2) and sex-determining region Y-box 2 (SOX2) were investigated as potential biomarkers that may distinguish between distinct CPT grades. Immunohistochemistry was used to determine the expression of NG2 and SOX2 in CPTs (n=34) from Chinese patients (21 males and 13 females) with a mean age of 31.1 years (range, 1-63 years). The proportion of cells stained were scored using a scale between 0 and 3+, where 0 represents no staining and 3+ represents strong staining, and mean scores for each marker were determined on the basis of tumor grade. Pathological diagnosis revealed a distribution of cases as follows: CPP, 25; ACPP, 5; and CPC, 4. NG2 and SOX2 were expressed in CPTs of all grades. The mean labeling indices for CPP, ACPP and CPC were 1.12, 1.80 and 2.75 for NG2, respectively, and 1.20, 2.00 and 3.00 for SOX2, respectively. Statistical analysis of the mean labeling indices revealed a significant association between the expression of NG2 and SOX2 and CPT grade (P= 0.001 and <0.001 for CPP/ACPP and CPP/CPC, respectively). The results of the present study indicated that increased expression of NG2 and SOX2 was associated with higher-grade tumors and that these markers may be useful in determining CPT grade. IntroductionChoroid plexus tumors (CPTs) are rare intracranial neoplasms that derive from the choroid plexus epithelium of the ventricles (1,2). The lesions are commonly located in the lateral and the fourth ventricles, and rarely in the cerebellopontine angle and the third ventricle (3,4). The majority of CPTs arise with clinical symptoms that are associated with hydrocephalus as a result of direct mechanical obstruction of the flow of cerebrospinal fluid (CSF) and arachnoid granulation blockage from hemorrhage and overproduction of CSF (1,5).Treatment of CPTs is currently based on histological diagnosis. According to the World Health Organization (WHO) classification scheme, CPTs are diagnosed as choroid plexus papilloma (CPP, WHO grade I), atypical choroid plexus papilloma (ACPP, WHO grade II) and choroid plexus carcinoma (CPC, WHO grade III) (3). For all classifications, the general treatment strategy is surgical resection unless this is not possible due to tumor location, for example. Gross total resection (GTR) is the indicated course of treatment for CPP as well as for ACPP. CPP is a benign neoplasm and recurrence following GTR is rare, therefore adjuvant radiotherapy and chemotherapy are not generally recommended (2,3,6,7). ACPP cases exhibit atypical histological features along with increased mitotic activity; however, patients with this type of tumor also e...

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Risk Factors Associated With Postcraniotomy Meningitis

Cited by 119 publications

References 50 publications

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

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

Antimicrobial prophylaxis at neurosurgical department of a major hospital in china: compare of cross sectional studies

Increased NG2 and SOX2 expression is associated with high-grade choroid plexus tumors

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