Chen Chang-Hua, Chang Chih-Yen, Lin Li-Jhen, Chen Wei Liang, Chang Yu-Jun, Wang Shu-Hui, Cheng Chun-Yuan, Yen Hua-Cheng
Division of Infectious Disease, Department of Internal Medicine Infection Control Committee Department of Medical Imaging Epidemiology and Biostatistics Center Department of Neurosurgery Division of Critical Care Medicine Changhua Christian Hospital, Changhua Department of Nursing, College of Medicine and Nursing, Hung Kuang University, Taichung County, Taiwan.
Medicine (Baltimore). 2016 Aug;95(31):e4329. doi: 10.1097/MD.0000000000004329.
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.
开颅术后脑膜炎（PCM）是神经外科面临的一项重大挑战，并且已注意到PCM中感染病原体模式的变化。有限的流行病学数据和迫切的临床需求推动了这项研究。我们开展这项研究以确定PCM的风险评估以及当前感染病原体的模式。我们对彰化基督教医院系统在2008年1月1日至2012年12月31日期间开颅术后脑膜炎的重大病例进行了一项回顾性病例对照研究。4392例手术患者中有22例被诊断为开颅术后脑膜炎；对这些数据进行了风险评估回顾。本研究评估了开颅术后脑膜炎的风险因素，发现其在老年患者中更常见（比值比[OR]=1.57，95%置信区间[CI]=1.32 - 2.98，P = 0.013）、接受急诊手术（OR = 4.82，95% CI = 1.50 - 14.53，P = 0.008）、有脑脊液漏（OR = 4.62，95% CI = 2.03 - 10.50，P = 0.012）、有脑室外引流（OR = 4.68，95% CI = 2.46 - 8.87，P = 0.006）、入住重症监护病房（OR = 2.41，95% CI = 1.53 - 8.08，P = 0.012）、引流管放置时间>72小时（OR = 2.66，95% CI = 1.04 - 4.29，P = 0.007）、手术时间>4.5小时（OR = 2.38，95% CI = 1.39 - 4.05，P = 0.005）、接受再次手术（OR = 2.74，95% CI = 1.31 - 5.73，P = 0.018）、遭受创伤（OR = 5.97，95% CI = 1.57 - 17.61，P = 0.007）或有30天死亡率（OR = 5.07，95% CI = 2.20 - 11.48，P = 0.001）的患者中更常见。从脑脊液中分离出的主要病原体为8例患者中的金黄色葡萄球菌（36.7%）和7例患者中的鲍曼不动杆菌（31.8%）。在我们的研究中，所有开颅术后患者的死亡率为5.1%。准确的风险评估、早期诊断以及根据流行病学信息选择合适的抗生素是降低PCM死亡率和发病率的基石。PCM中感染病原体随时间的变化模式表明有必要进行进一步研究，以便为医生提供最新的见解。
