Risk factors associated with postcraniotomy meningitis

Chen, Changhua; Chang, Chun-Ming; Lin, Li-Jhen; Chen, Wei‐Liang; Chang, Yu-Jun; Wang, Shuhui; Cheng, Chun-Yuan; Yen, Hua-Cheng

doi:10.1097/md.0000000000004329

Cited by 20 publications

(30 citation statements)

References 21 publications

(35 reference statements)

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“…However, dura and skin can sometimes not be adequately sutured due to excessive cerebral edema in patients, whose ICP is extremely high. There were also several reports on the positive association between external ventricular drainage and meningitis [8,9,29]. The endocranial space, which normally has no communication with the outside, is connected with the outside by decompressive craniectomy and external ventricular drainage, and bacteria might invade the endocranial space and cause meningitis.…”

Section: Discussionmentioning

confidence: 99%

“…Repeat surgery is often performed in head trauma patients because of intracranial hematoma on the opposite side after n/N number of patients with posttraumatic meningitis/number of patients, TBI traumatic brain injury, ED emergency department, OR odds ratio, CI confidence interval, NA not applicable *When assessing one variable, we adjusted other variables listed in this table the initial surgery or cerebral edema after brain contusion. Long operation time and repeat surgery were associated with postoperative meningitis in patients undergoing neurosurgery [9]. In addition, not only trauma but also therapeutic interventions such as surgery affect the immune response of the trauma patients [30].…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies revealed that basilar skull fracture and cerebrospinal fluid (CSF) leakage were also associated with posttraumatic meningitis [6,7]. In addition, the length of time of external ventricular drainage, emergency operation, and operation time over 4.5 h was also reported to relate to the occurrence of postoperative meningitis in patients undergoing a neurosurgical operation [8,9].…”

Section: Introductionmentioning

confidence: 99%

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Factors associated with posttraumatic meningitis among traumatic head injury patients: a nationwide study in Japan

Katayama

Kitamura

Kiyohara

et al. 2019

Eur J Trauma Emerg Surg

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Purpose Posttraumatic meningitis is one of the severe complications that can result in increased mortality and longer hospital stay among trauma patients. Factors such as cerebrospinal fluid (CSF) fistula and basilar skull fracture are associated with posttraumatic meningitis. However, it remains unclear whether procedures such as burr hole surgery in the emergency department and decompressive craniectomy are associated with posttraumatic meningitis. The aim of this study was to assess factors associated with posttraumatic meningitis with a nationwide hospital-based trauma registry in Japan. Methods This was a retrospective observational study with a 12-year study period from January 2004 to December 2015. We included trauma patients registered in the Japanese Trauma Data Bank, whose head Abbreviated Injury Scale score was ≥ 3 in this study. The main endpoint was the occurrence of meningitis during hospitalization. Multivariable logistic regression analysis was used to assess independent parameters associated with posttraumatic meningitis such as CSF fistula, burr hole surgery in the emergency department, and decompressive craniectomy. Results Among 60,390 head injury patients with head AIS score 3 or more, 284 (0.5%) patients had posttraumatic meningitis. Factors associated with posttraumatic meningitis were burr hole surgery in the emergency department (adjusted odds ratio [AOR] 2.158 [95% confidence interval (CI) 1.401-3.325]), decompressive craniectomy (AOR 2.123 [95% CI 1.506-2.993]), external ventricular drainage (AOR 1.843 [95% CI, 1.157-2.935]), CSF leakage (AOR 3.328 [95% CI 2.205-5.022]), and basilar skull fracture (AOR 1.651 [95% CI 1.178-2.314]).Conclusions In this population of trauma patients, burr hole surgery in the emergency department and decompressive craniectomy was associated with posttraumatic meningitis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Factors associated with posttraumatic meningitis among traumatic head injury patients: a nationwide study in Japan

Katayama

Kitamura

Kiyohara

et al. 2019

Eur J Trauma Emerg Surg

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“…Yaş, cinsiyet ve diabetes mellitus ya da kronik böbrek yetersizliği gibi kronik hastalıkların NKM riskini arttırmadıkları öne sürülmektedir (11,12,16 Penetran kafa travmalarında menenjit riskinin yüksek olduğu belirtilmektedir (10,13). Bizim serimizde bir olgu penetran kafa travmasıydı.…”

Section: Discussionunclassified

“…EVDK ile ilişkili NKM'lerde etken olarak koagülaz negatif stafilokoklar ön plandayken bazı hasta serilerinde Gram-negatif bakteriler daha fazla izole edilmiştir (8,9). Kraniyotomi sonrasında gelişen NKM'lerde Gram-negatif basiller ve Stafiloccusus aureus en fazla izole edilen etkenlerdir (10).…”

Section: Introductionunclassified

The Effects of Corticosteroid Use on Prognosis of Patients with Nosocomial Meningitis in Neurosurgical Intensive Care Unit: A Retrospective Descriptive Study

Akçıl¹,

Dilmen²,

Gönen³

et al. 2018

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Beyin cerrahisi yoğun bakım hastalarında kraniyotomiler, eksternal ventrikül drenaj kateteri gibi invaziv uygulamalar ve penetran kafa travmaları nozokomiyal menenjit gelişme riskini arttırmaktadır. Kortikosteroid kullanımının da bu riski arttırdığını gösteren çalışmalar olduğu gibi tersini savunan çalışmalar da bulunmaktadır. Bu retrospektif tanımlayıcı çalışmanın amacı 5 yıl süresince beyin cerrahisi yoğun bakım ünitesinde nozokomiyal menenjit gelişen hastalarda kortikosteroid kullanımının mortalite, nozokomiyal enfeksiyon, cerrahi girişim sayısı ve yoğun bakım yatış süresi üzerine etkisini ortaya koymaktır. Gereç ve Yöntem: Bu çalışmada 5 yıllık sürede beyin cerrahisi yoğun bakım ünitesinde yatan 2228 hastadan nozokomiyal menenjit gelişen 13 olgu retrospektif olarak incelendi. Nozokomiyal menenjit gelişen hastalarda kortikosteroid kullanımının mortalite, nozokomiyal enfeksiyon, cerrahi girişim sayısı ve yoğun bakım yatış süresi üzerine etkisi araştırılmıştır. Bulgular: Kortikosteroid kullanımının nozokomiyal menenjiti olan hastalarda mortalite, nozokomiyal enfeksiyon riski, cerrahi girişim sayısı ve yoğun bakım yatış süresi üzerine etkisi bulunmadı (p>0,05). Sonuç: Nozokomiyal menenjiti olan beyin cerrahisi yoğun bakım hastalarında, kortikosteroid kullanımı; mortalite, nozokomiyal enfeksiyon riski, cerrahi girişim sayısı ve yoğun bakım yatış süresini etkilememektedir. Anahtar Kelimeler: Nozokomiyal menenjit, kortikosteroidler, beyin cerrahisi yoğun bakım ünitesi ABSTRACT Objective: Invasive procedures such as craniotomies, external ventricular drainage catheters, and penetrating head traumas increase the risk of nosocomial meningitis in neurosurgical intensive care unit patients. While some studies suggest that corticosteroids increase this risk, others argue no such effect present. The aim of this retrospective descriptive study was to reveal the effect of corticosteroid use in patients with nosocomial meningitis in the neurosurgical intensive care unit for five years on mortality, nosocomial infection, the number of surgical interventions and the duration of stay in intensive care unit. Materials and Methods: In this study, 13 cases that developed nosocomial meningitis from 2228 patients in the neurosurgical intensive care unit during a 5-year period were retrospectively analyzed. The effects of corticosteroid use on mortality, nosocomial infections, number of surgical interventions and length of stay in intensive care unit were investigated in patients with nosocomial meningitis. Results: The use of corticosteroid in patients with nosocomial meningitis had no effect on mortality, nosocomial infection risk, number of surgical interventions and length of stay in intensive care unit (p>0.05). Conclusion: Corticosteroid use of neurosurgical intensive care unit patients with nosocomial meningitis does not affect mortality, nosocomial infection risk, number of surgical interventions and length of stay in intensive care unit.

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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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Risk factors associated with postcraniotomy meningitis

Abstract: Supplemental Digital Content is available in the text

Cited by 20 publications

References 21 publications

Factors associated with posttraumatic meningitis among traumatic head injury patients: a nationwide study in Japan

Factors associated with posttraumatic meningitis among traumatic head injury patients: a nationwide study in Japan

The Effects of Corticosteroid Use on Prognosis of Patients with Nosocomial Meningitis in Neurosurgical Intensive Care Unit: A Retrospective Descriptive Study

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

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