engleski

Healthcare-associated meningitis and ventriculitis - a 5-year overview of hospitalized patients in a tertiary healthcare centre

Background: Healthcare-associated meningitis and ventriculitis (HCAMV) are serious complications of neurosurgical procedures associated with significant morbidity, mortality and added cost of care. The aim of this study was to describe clinical and microbiological findings, complications and outcomes of HCAMV. Materials/methods: We performed a retrospective, cohort study of consecutive adult patients diagnosed with HCAMV at the University Hospital for Infectious Diseases Zagreb in a 5-year period (2013-2017). We describe our data with frequencies and medians with first and third quartile. Results: A total of 104 patients were included ; the median age was 52 (34-64) years ; 66 (63.5%) were males. The most common indications for neurosurgical procedures were brain tumor (53, 51.0%), hydrocephalus (35, 33.7%), hemorrhage (32, 30.8%) and trauma (21, 20.2%). External ventricular (EVD) or ventriculoperitoneal (VP) drain was placed in 24 (23.1%) patients. The majority of patients presented with fever (88, 84.6%), headache (67, 64.4%), changes in mental status (63, 60.6%) and focal neurological deficit (53, 13.1%). The median CSF white blood cell count was 426/mm3 (80- 1706), protein 1.46 g/L (0.88- 2.65) and glucose 2.14 mmol/L (1.1-3.1). Etiology was identified in 63 (60.6%) patients: CSF culture was positive in 52/102 (51.0%), Gram stain in 17/85 (20.0%), 16s rRNA PCR in 6/58 (10.3%) ; 7/101 (6.9%) had concurrent bacteremia. Acinetobacter baumannii (18, 28.6%) was the most common pathogen, followed by Coagulase-negative Staphylococcus (16, 25.4%), Pseudomonas spp. (8, 12.8%), Enterobacter spp. (5, 7.9%), MSSA (4, 6.3%) and MRSA (2, 3.2%) ; 10 patients (15.87%) had polymicrobial infections. The majority of patients (85, 81.7%) were admitted to the intensive care unit (ICU): 31 (29.8%) required mechanical ventilation for the median duration of 15 (6-31) days. EVD was placed in 54 (51.9%) patients and subsequently converted to VP in 22 (21.2%) patients. The median duration of hospitalization was 23 (15-42) days. 17 (16.3%) patients died and the majority had adverse outcomes: persistent vegetative state in 10 (9.6%), severe disability in 24 (23.1%) and moderate disability in 20 (19.2%). Conclusions: HCAMV are associated with multidrug-resistant pathogens, prolonged hospitalization and ICU stay, occurrence of complications and poor clinical outcomes. This highlights the importance of adequate perioperative antibiotic prophylaxis.

Healthcare-associated ; meningitis ; ventriculitis ; tertiary healthcare centre

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