Limits...
Risk factors associated with postcraniotomy meningitis: A retrospective study.

Chen CH, Chang CY, Lin LJ, Chen WL, Chang YJ, Wang SH, Cheng CY, Yen HC - Medicine (Baltimore) (2016)

Bottom Line: The predominant pathogens isolated from cerebrospinal fluid were Staphylococcus aureus in 8 patients (36.7%) and Acinetobacter baumannii in 7 patients (31.8%).In our study, the mortality rate was 5.1% among all postcraniotomy patients.Accurate risk assessment, early diagnosis, and choice of appropriate antibiotics in accordance with epidemiologic information are the cornerstones of reducing mortality and morbidity in PCM.The changing pattern of infectious agents in PCM over time suggests the necessity of further studies to provide the most up-to-date insight to physicians.

View Article: PubMed Central - PubMed

Affiliation: aDivision of Infectious Disease, Department of Internal Medicine bInfection Control Committee cDepartment of Medical Imaging dEpidemiology and Biostatistics Center eDepartment of Neurosurgery fDivision of Critical Care Medicine Changhua Christian Hospital, Changhua gDepartment of Nursing, College of Medicine and Nursing, Hung Kuang University, Taichung County, Taiwan.

ABSTRACT
Postcraniotomy meningitis (PCM) is a major challenge in neurosurgery, and changing patterns of infectious agents in PCM have been noted. The limited epidemiological data and urgent clinical needs motivated this research. We conducted this study to determine a risk assessment for PCM and the current pattern of infectious agents.We performed a retrospective case-control study of significant cases of postcraniotomy meningitis in the Changhua Christian Hospital System between January 1, 2008, and December 31, 2012. Postcraniotomy meningitis was diagnosed in 22 out of 4392 surgical patients; this data was reviewed for risk assessment.This study assessed the risk factors for postcraniotomy meningitis and found that it was more frequently seen in patients who were elderly (OR = 1.57, 95% CI = 1.32-2.98, P = 0.013), underwent emergency procedures (OR = 4.82, 95% CI = 1.50-14.53, P = 0.008), had leak of cerebrospinal fluid (OR = 4.62, 95% CI = 2.03-10.50, P = 0.012), had external ventricular drainage (OR = 4.68, 95% CI = 2.46-8.87, P = 0.006), were admitted to the intensive care unit (OR = 2.41, 95% CI = 1.53-8.08, P = 0.012), had used drain placement >72 hours (OR = 2.66, 95% CI = 1.04-4.29, P = 0.007), had surgery >4.5 hours (OR = 2.38, 95% CI = 1.39-4.05, P = 0.005), had repeat operations (OR = 2.74, 95% CI = 1.31-5.73, P = 0.018), endured trauma (OR = 5.97, 95% CI = 1.57-17.61, P = 0.007), or had 30-days mortality (OR = 5.07, 95% CI = 2.20-11.48, P = 0.001). The predominant pathogens isolated from cerebrospinal fluid were Staphylococcus aureus in 8 patients (36.7%) and Acinetobacter baumannii in 7 patients (31.8%). In our study, the mortality rate was 5.1% among all postcraniotomy patients.Accurate risk assessment, early diagnosis, and choice of appropriate antibiotics in accordance with epidemiologic information are the cornerstones of reducing mortality and morbidity in PCM. The changing pattern of infectious agents in PCM over time suggests the necessity of further studies to provide the most up-to-date insight to physicians.

No MeSH data available.


Related in: MedlinePlus

Study flowchart showing the selection of subjects.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4979789&req=5

Figure 1: Study flowchart showing the selection of subjects.

Mentions: The study flowchart showing the selection of subjects during the study period is shown in Fig. 1. During the study period, PCM was diagnosed in 22 out of 4392 (1.4%) surgical patients (Table 1). The period prevalence of PCM in CCHS was 134.4 ± 76.8 per 100,000 patient-years. The incidence of PCM was 1.4% among 4392 surgical patients in CCHS. A total of 3455 (3455/4392, 78.7%) patients were male and the mean age [± SD] was 45 ± 13.8 years. The craniotomies were performed as emergency procedures in 2524 (72.3%) patients. In total, 1256 (28.6%) patients had EVD, and 1160 (26.4%) patients were admitted to the intensive care unit (ICU). The medium period from admission to diagnosis of PCM was 10.5 ± 2.1 days (range, 2–30 days). The mean hospitalization duration was 18.6 ± 3.1 days (range, 2–69 days) and the mean postcraniotomy hospitalization duration was 6.32 ± 1.5 days (range, 1–35 days). The overall mortality rate of patients who received craniotomy was 5.5% (242/4392).


Risk factors associated with postcraniotomy meningitis: A retrospective study.

Chen CH, Chang CY, Lin LJ, Chen WL, Chang YJ, Wang SH, Cheng CY, Yen HC - Medicine (Baltimore) (2016)

Study flowchart showing the selection of subjects.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4979789&req=5

Figure 1: Study flowchart showing the selection of subjects.
Mentions: The study flowchart showing the selection of subjects during the study period is shown in Fig. 1. During the study period, PCM was diagnosed in 22 out of 4392 (1.4%) surgical patients (Table 1). The period prevalence of PCM in CCHS was 134.4 ± 76.8 per 100,000 patient-years. The incidence of PCM was 1.4% among 4392 surgical patients in CCHS. A total of 3455 (3455/4392, 78.7%) patients were male and the mean age [± SD] was 45 ± 13.8 years. The craniotomies were performed as emergency procedures in 2524 (72.3%) patients. In total, 1256 (28.6%) patients had EVD, and 1160 (26.4%) patients were admitted to the intensive care unit (ICU). The medium period from admission to diagnosis of PCM was 10.5 ± 2.1 days (range, 2–30 days). The mean hospitalization duration was 18.6 ± 3.1 days (range, 2–69 days) and the mean postcraniotomy hospitalization duration was 6.32 ± 1.5 days (range, 1–35 days). The overall mortality rate of patients who received craniotomy was 5.5% (242/4392).

Bottom Line: The predominant pathogens isolated from cerebrospinal fluid were Staphylococcus aureus in 8 patients (36.7%) and Acinetobacter baumannii in 7 patients (31.8%).In our study, the mortality rate was 5.1% among all postcraniotomy patients.Accurate risk assessment, early diagnosis, and choice of appropriate antibiotics in accordance with epidemiologic information are the cornerstones of reducing mortality and morbidity in PCM.The changing pattern of infectious agents in PCM over time suggests the necessity of further studies to provide the most up-to-date insight to physicians.

View Article: PubMed Central - PubMed

Affiliation: aDivision of Infectious Disease, Department of Internal Medicine bInfection Control Committee cDepartment of Medical Imaging dEpidemiology and Biostatistics Center eDepartment of Neurosurgery fDivision of Critical Care Medicine Changhua Christian Hospital, Changhua gDepartment of Nursing, College of Medicine and Nursing, Hung Kuang University, Taichung County, Taiwan.

ABSTRACT
Postcraniotomy meningitis (PCM) is a major challenge in neurosurgery, and changing patterns of infectious agents in PCM have been noted. The limited epidemiological data and urgent clinical needs motivated this research. We conducted this study to determine a risk assessment for PCM and the current pattern of infectious agents.We performed a retrospective case-control study of significant cases of postcraniotomy meningitis in the Changhua Christian Hospital System between January 1, 2008, and December 31, 2012. Postcraniotomy meningitis was diagnosed in 22 out of 4392 surgical patients; this data was reviewed for risk assessment.This study assessed the risk factors for postcraniotomy meningitis and found that it was more frequently seen in patients who were elderly (OR = 1.57, 95% CI = 1.32-2.98, P = 0.013), underwent emergency procedures (OR = 4.82, 95% CI = 1.50-14.53, P = 0.008), had leak of cerebrospinal fluid (OR = 4.62, 95% CI = 2.03-10.50, P = 0.012), had external ventricular drainage (OR = 4.68, 95% CI = 2.46-8.87, P = 0.006), were admitted to the intensive care unit (OR = 2.41, 95% CI = 1.53-8.08, P = 0.012), had used drain placement >72 hours (OR = 2.66, 95% CI = 1.04-4.29, P = 0.007), had surgery >4.5 hours (OR = 2.38, 95% CI = 1.39-4.05, P = 0.005), had repeat operations (OR = 2.74, 95% CI = 1.31-5.73, P = 0.018), endured trauma (OR = 5.97, 95% CI = 1.57-17.61, P = 0.007), or had 30-days mortality (OR = 5.07, 95% CI = 2.20-11.48, P = 0.001). The predominant pathogens isolated from cerebrospinal fluid were Staphylococcus aureus in 8 patients (36.7%) and Acinetobacter baumannii in 7 patients (31.8%). In our study, the mortality rate was 5.1% among all postcraniotomy patients.Accurate risk assessment, early diagnosis, and choice of appropriate antibiotics in accordance with epidemiologic information are the cornerstones of reducing mortality and morbidity in PCM. The changing pattern of infectious agents in PCM over time suggests the necessity of further studies to provide the most up-to-date insight to physicians.

No MeSH data available.


Related in: MedlinePlus