Neurosurgical Meningitis: Clinico-Microbiological Profile and Treatment Outcome from a Tertiary Care Center in India
Abstract Background Meningitis following neurosurgical procedure is a well-recognized and potentially fatal complication. The Indian literature on microbiological epidemiology is scarce. The aim of our study was to know clinical, microbiological profile and treatment outcomes of patient...
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| Format: | Article |
| Language: | English |
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Thieme Medical Publishers, Inc.
2015-03-01
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| Series: | Indian Journal of Neurosurgery |
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| Online Access: | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0035-1549112 |
| _version_ | 1811331571101204480 |
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| author | Ravikant Porwal Abdul Ghafur Vidyalakshmi P. R. Priyadarshini Kannaian Pradeepa Arivazhaghan |
| author_facet | Ravikant Porwal Abdul Ghafur Vidyalakshmi P. R. Priyadarshini Kannaian Pradeepa Arivazhaghan |
| author_sort | Ravikant Porwal |
| collection | DOAJ |
| description | Abstract
Background Meningitis following neurosurgical procedure is a well-recognized and potentially fatal complication. The Indian literature on microbiological epidemiology is scarce. The aim of our study was to know clinical, microbiological profile and treatment outcomes of patients with neurosurgical meningitis at our center.
Methods This was a retrospective observational cohort study of 25 culture-proven neurosurgical meningitis cases performed at the Apollo Speciality Hospital, Chennai, India, between January 2009 and May 2012.
Results In our study, nine patients had skull fracture and cerebrospinal fluid leak, nearly 50% of the patients underwent craniotomy, and five patients had endoscopic surgery while 64% of the patients required shunt placement or drains. Only nine patients (36%) had definite clinical signs of meningitis and mean duration of onset of symptoms from surgery was 11.12 days. A total of 18 patients (72%) had gram-negative bacterial meningitis and majority (83.3%) was due to carbapenem-resistant organisms. Predominant isolate was Pseudomonas aeruginosa (44.4%), and the second most common isolate was Acinetobacter baumannii (33.3%). Among cases of gram-negative bacterial meningitis, patients who had carbapenem-resistant isolates were given combination antimicrobials (carbapenem/cefepime tazobactam with colistin/gentamicin) as per susceptibility via intravenous and intrathecal through the drain (extraventricular or lumbar). Only five patients (27.7%) had a complete cure.
Conclusion Gram-negative organisms, mainly Pseudomonas and Acinetobacter, are predominant pathogen in neurosurgical meningitis in our center. While treating multidrug-resistant gram-negative meningitis, device removal and a combination of antimicrobial agents via both intravenous and intraventricular routes are crucial to achieve cure. |
| first_indexed | 2024-04-13T16:22:38Z |
| format | Article |
| id | doaj.art-1bd2adc8fe8c4249b3ad6faff9da8c83 |
| institution | Directory Open Access Journal |
| issn | 2277-954X 2277-9167 |
| language | English |
| last_indexed | 2024-04-13T16:22:38Z |
| publishDate | 2015-03-01 |
| publisher | Thieme Medical Publishers, Inc. |
| record_format | Article |
| series | Indian Journal of Neurosurgery |
| spelling | doaj.art-1bd2adc8fe8c4249b3ad6faff9da8c832022-12-22T02:39:51ZengThieme Medical Publishers, Inc.Indian Journal of Neurosurgery2277-954X2277-91672015-03-01040100200710.1055/s-0035-1549112Neurosurgical Meningitis: Clinico-Microbiological Profile and Treatment Outcome from a Tertiary Care Center in IndiaRavikant Porwal0Abdul Ghafur1Vidyalakshmi P. R.2Priyadarshini Kannaian3Pradeepa Arivazhaghan4Department of Infectious Diseases, Apollo Hospitals, Chennai, IndiaDepartment of Infectious Diseases, Apollo Hospitals, Chennai, IndiaDepartment of Infectious Diseases, Apollo Hospitals, Chennai, IndiaApollo Speciality Hospitals, Chennai, IndiaApollo Speciality Hospitals, Chennai, IndiaAbstract Background Meningitis following neurosurgical procedure is a well-recognized and potentially fatal complication. The Indian literature on microbiological epidemiology is scarce. The aim of our study was to know clinical, microbiological profile and treatment outcomes of patients with neurosurgical meningitis at our center. Methods This was a retrospective observational cohort study of 25 culture-proven neurosurgical meningitis cases performed at the Apollo Speciality Hospital, Chennai, India, between January 2009 and May 2012. Results In our study, nine patients had skull fracture and cerebrospinal fluid leak, nearly 50% of the patients underwent craniotomy, and five patients had endoscopic surgery while 64% of the patients required shunt placement or drains. Only nine patients (36%) had definite clinical signs of meningitis and mean duration of onset of symptoms from surgery was 11.12 days. A total of 18 patients (72%) had gram-negative bacterial meningitis and majority (83.3%) was due to carbapenem-resistant organisms. Predominant isolate was Pseudomonas aeruginosa (44.4%), and the second most common isolate was Acinetobacter baumannii (33.3%). Among cases of gram-negative bacterial meningitis, patients who had carbapenem-resistant isolates were given combination antimicrobials (carbapenem/cefepime tazobactam with colistin/gentamicin) as per susceptibility via intravenous and intrathecal through the drain (extraventricular or lumbar). Only five patients (27.7%) had a complete cure. Conclusion Gram-negative organisms, mainly Pseudomonas and Acinetobacter, are predominant pathogen in neurosurgical meningitis in our center. While treating multidrug-resistant gram-negative meningitis, device removal and a combination of antimicrobial agents via both intravenous and intraventricular routes are crucial to achieve cure.http://www.thieme-connect.de/DOI/DOI?10.1055/s-0035-1549112neurosurgical meningitismultidrug-resistant gram-negative meningitiscarbapenem-resistant meningitis |
| spellingShingle | Ravikant Porwal Abdul Ghafur Vidyalakshmi P. R. Priyadarshini Kannaian Pradeepa Arivazhaghan Neurosurgical Meningitis: Clinico-Microbiological Profile and Treatment Outcome from a Tertiary Care Center in India Indian Journal of Neurosurgery neurosurgical meningitis multidrug-resistant gram-negative meningitis carbapenem-resistant meningitis |
| title | Neurosurgical Meningitis: Clinico-Microbiological Profile and Treatment Outcome from a Tertiary Care Center in India |
| title_full | Neurosurgical Meningitis: Clinico-Microbiological Profile and Treatment Outcome from a Tertiary Care Center in India |
| title_fullStr | Neurosurgical Meningitis: Clinico-Microbiological Profile and Treatment Outcome from a Tertiary Care Center in India |
| title_full_unstemmed | Neurosurgical Meningitis: Clinico-Microbiological Profile and Treatment Outcome from a Tertiary Care Center in India |
| title_short | Neurosurgical Meningitis: Clinico-Microbiological Profile and Treatment Outcome from a Tertiary Care Center in India |
| title_sort | neurosurgical meningitis clinico microbiological profile and treatment outcome from a tertiary care center in india |
| topic | neurosurgical meningitis multidrug-resistant gram-negative meningitis carbapenem-resistant meningitis |
| url | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0035-1549112 |
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