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Early Intraventricular Antibiotic Therapy Improved In-Hospital-Mortality in Neurocritical Patients with Multidrug-Resistant Bacterial Nosocomial Meningitis and Ventriculitis

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Abstract

Background

Hospital-acquired multidrug-resistant (MDR) bacterial meningitis and/or ventriculitis (MEN) is a severe condition associated with high mortality. The risk factors related to in-hospital mortality of patients with MDR bacterial MEN are unknown. We aimed to examine factors related to in-hospital mortality and evaluate their prognostic value in patients with MDR bacterial MEN treated in the neurointensive care unit.

Methods

This was a single-center retrospective cohort study of critically ill neurosurgical patients with MDR bacterial MEN admitted to our hospital between January 2003 and March 2021. Data on demographics, admission variables, treatment, time to start of intraventricular (IVT) therapy, and in-hospital mortality were analyzed. Both univariate and multivariable analyses were performed to identify determinants of in-hospital mortality.

Results

All 142 included patients received systemic antibiotic therapy, and 102 of them received concomitant IVT treatment. The median time to start of IVT treatment was 2 days (interquartile range 1–5 days). The time to start of IVT treatment had an effect on in-hospital mortality (hazard ratio 1.17; 95% confidence interval 1.02–1.34; adjusted p = 0.030). The cutoff time to initiate IVT treatment was identified at 3 days: patients treated within 3 days had a higher cerebrospinal fluid (CSF) sterilization rate (81.5%) and a shorter median time to CSF sterilization (7 days) compared with patients who received delayed IVT treatment (> 3 days) (48.6% and 11.5 days, respectively) and those who received intravenous antibiotics alone (42.5% and 10 days, respectively).

Conclusions

Early IVT antibiotics were associated with superior outcomes in terms of the in-hospital mortality rate, time to CSF sterilization, and CSF sterilization rate compared with delayed IVT antibiotics and intravenous antibiotics alone.

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Acknowledgements

We thank Dr. Xiaofei Jiang for their enabling of convenience in data collection.

Funding

This study was supported by National Natural Science Foundation of China (NSFC Grants 82101858, 81571111, and 81701206).

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Authors and Affiliations

  1. Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Middle Wulumuqi Road 12#, Jing’an District, Shanghai, 200040, China

    Zhiqi Li, Weijian Yang, Qiang Yuan, Jianlan Zhao, Zhuoying Du, Jian Yu, Yirui Sun, Xuehai Wu & Jin Hu

  2. Neuro-intensive Care Unit, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China

    Xiangru Ye

  3. Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China

    Zhiqi Li, Weijian Yang, Qiang Yuan, Jianlan Zhao, Zhuoying Du, Jian Yu, Yirui Sun, Xuehai Wu & Jin Hu

  4. Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China

    Zhiqi Li, Weijian Yang, Qiang Yuan, Jianlan Zhao, Zhuoying Du, Jian Yu, Yirui Sun, Xuehai Wu & Jin Hu

Authors
  1. Zhiqi Li
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  2. Weijian Yang
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  10. Jin Hu
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Contributions

The study was designed by ZL and JH, and data collection was performed by ZL, WY, and XY. Results were analyzed by ZL, WY, XY, QY, JZ, and ZD. JY, YS, XW, and JH coordinated the project. ZL, WY, and JH wrote the article. JH supervised the study and made critical revision of the manuscript. All authors approved the final version of the manuscript.

Corresponding author

Correspondence to Jin Hu.

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Conflict of interest

All authors have disclosed that they do not have a potential conflict of interest.

Ethical Approval/Informed Consent

The procedures followed were in accordance with the ethical standards of the Ethics Committee for the Evaluation of Biomedical Research Projects of Huashan Hospital and with the Helsinki Declaration of the World Medical Association. Informed consent was obtained from the patients’ next of kin.

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Li, Z., Yang, W., Ye, X. et al. Early Intraventricular Antibiotic Therapy Improved In-Hospital-Mortality in Neurocritical Patients with Multidrug-Resistant Bacterial Nosocomial Meningitis and Ventriculitis. Neurocrit Care 40, 612–620 (2024). https://doi.org/10.1007/s12028-023-01781-7

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