The characteristics of post-neurosurgical bacterial meningitis in elective neurosurgery in 2012: A single institute study

https://doi.org/10.1016/j.clineuro.2015.09.002Get rights and content

Highlights

  • First report characteristics of post-neurosurgical meningitis for a single year.

  • Incidence of post-neurosurgical meningitis in the autumn and winter was higher.

  • Gram+ is the most common causative pathogens in the northern mainland of China.

  • Incidence of Gram− related bacterial meningitis in spring was significantly higher.

Abstract

Objective

Most post-neurosurgical meningitis research has been focused on large cohorts with numerous cases followed over several years. However, the characteristics of post-neurosurgical meningitis in an entire single year are still unclear, and knowledge of these characteristics might influence the selection of appropriate antibiotics and therapeutic strategies for the successful management of this disease. Our aim is to obtain a better understanding of post-neurosurgical meningitis over a single entire year.

Materials and methods

Patients with positive meningitis cultures after neurosurgical operations in our hospital during the entire year of 2012 were included in the analysis. We report demographic characteristics, morbidity during different seasons, clinical and bacteriological profiles, sensitivity to antibiotics and causes of the post-neurosurgical meningitis infections in our cohort.

Results

Of the 6407 patients who underwent neurosurgical procedures during the study period, 146 developed post-neurosurgical meningitis and the overall incidence of meningitis was 2.28%. The incidence of meningitis was significantly higher in patients who underwent surgery in the autumn and winter than spring or summer (p = 0.000). The most common organisms causing meningitis were Gram-positive bacteria, followed by the Klebsiella and Baumannii species. Compound sulfamethoxazole (52.6%) and vancomycin (10.5%) were the most active antibiotics against Gram-positive bacteria strains, whereas meropenem (43.8%) and polymyxin (18.8%) were active against Gram-negative bacillus strains.

Conclusions

Post-neurosurgical meningitis usually occurs in the autumn and winter of the year in our hospital. Gram-positive organisms, which are sensitive to compound sulfamethoxazole and vancomycin, are the most common causative pathogens of post-neurosurgical meningitis in the northern mainland of China.

Introduction

Nosocomial infections are the most common causes of morbidity and mortality in patients with neurosurgical operations. Among the nosocomial infections, meningitis is the most dreaded infection and can lead to a variety of complications, including death. The diagnosis of meningitis requires a high degree of clinical suspicion and an examination of the cerebrospinal fluid (CSF). Post-neurosurgical meningitis is associated with increases in the duration of hospital stay and in the total cost of illness. Moreover, the management of post-neurosurgical bacterial meningitis is a therapeutic dilemma because of the associated neurosurgical procedures are complicated, diagnostic confirmation is difficult, and the appropriate antibiotics must be selected [1], [2], [3].

The reported incidence of post-neurosurgical meningitis is quite variable (0.5–8%) [4], [5]. The epidemiology of bacterial meningitis can be altered by several factors, including the various time periods of study, geographic distribution, age, race, underlying medical and/or neurosurgical conditions, means of contraction, status of vaccination, and use of antibiotics in the community [1]. Most of the post-neurosurgical meningitis study has been conducted with large cohorts with numerous cases followed over several years. However, the characteristics of meningitis after neurosurgery in an entire single year are still unclear, which might influence the therapeutic strategies of post-neurosurgical meningitis. In this article, we report the demographic characteristics, morbidity in the different seasons, clinical and bacteriological profiles, sensitivity to antibiotics and the causes of the post-neurosurgical meningitis at the department of neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China over the entire year of 2012 (2012.1.1–2012.12.31) to obtain a better understanding of postoperative meningitis after neurosurgery in a single year.

Section snippets

Subjects

This study was approved by the Research Ethics Committee of Beijing Tian Tan Hospital. This was a retrospective study, and the cohort included all patients who underwent various neurosurgical procedures in our hospital over a period of a single year. Our hospital is one of the largest neurosurgical centers in the northern mainland of China, with 6000–7000 routine neurosurgical operations each year.

Data Collection

Only patients with a positive culture for meningitis were included in this study for the analysis.

Demographic and operation characteristics

During the study period, 6407 patients underwent neurosurgical procedures, and the demographic and surgical characteristics of the meningitis cases are shown in Table 1. There were a total of 146 patients who developed post-neurosurgical meningitis. The overall incidence of post-neurosurgical meningitis was 2.28%, and the patients had a median age of 37.5 years. Four patients died during the study period, and the overall mortality was 2.76%, which includes the mortality caused by Klebsiella

Discussion

Bacterial meningitis is a serious post-neurosurgery complication, and these concomitant conditions are indicators of high morbidity and mortality [8]. Prevention of bacterial infections is one of the most important aspects of surgery, especially in neurosurgery, where a highly sterile environment is critically important. In addition to the mortality and morbidity, infections are associated with an enormous economic burden on both the patients and the hospital. Understanding the characteristics

Conclusion

In this study, we reviewed our experience with post-neurosurgical operative meningitis over a single entire year. The incidence of post-neurosurgical meningitis in the autumn and winter was higher than in the other seasons of the year and should be considered in regard to the prevention and treatment of this disease. Gram-positive organisms, which are sensitive to compound sulfamethoxazole and vancomycin, are the most common causative pathogens of causing post-neurosurgical meningitis in the

Conflicts of interest

The authors report no conflicts of interest.

Acknowledgements

This study was supported by the National Natural Science Foundation of China (No. 81171144 and No. 81471238), the Beijing Nova program (No. XX2012033), then National Key Technology Research and Development Program of the Ministry of Science and Technology of China (2013BAI09B03) and the Beijing Institute for Brain Disorders (BIBD-PXM2013_014226_07_000084).

References (14)

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These authors contributed equally to this work.

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