SAN DIEGO – Health care–associated meningitis or ventriculitis continues to occur despite well established preventive methods and is associated with significant morbidity and mortality, a long-term analysis at two hospitals showed.
“Health care–associated meningitis or ventriculitis remains challenging for providers in terms of diagnosis, treatment, and prevention,” Dr. Chanunya Srihawan said at an annual scientific meeting on infectious diseases. “Even though there are a lot of well described methods to minimize the risk of infection, we still see patients with health care–associated meningitis or ventriculitis in the hospital, and most of them have a poor outcome.”
Dr. Srihawan, of the division of infectious diseases in the department of internal medicine at the University of Texas, Houston, and her associates set out to describe the clinical characteristics of patients with health care–associated meningitis or ventriculitis, and to identify risk factors associated with clinical outcomes. They examined data from adult and pediatric patients with a diagnosis of health care–associated meningitis or ventriculitis based on the 2015 Centers for Disease Control and Prevention/National Healthcare Safety Network surveillance definition who were treated at two large tertiary care hospitals in Houston from July 2003 to November 2014.
Patients were prospectively identified by infection control clinicians and by screening of all cerebrospinal fluid samples sent to a central laboratory. The researchers collected patient information on demographics, clinical presentations, laboratory results, imaging studies, treatments, and clinical outcomes. They used Pearson chi-square and Fischer’s exact test for bivariate analysis between baseline variables and outcomes, followed by logistic regression analysis with bootstrap.
Dr. Srihawan reported results from 166 adult and 49 pediatric patients. The median age of patients was 45 years, 45% were white, 26% were Hispanic, 20% were African American, and the remainder were from other ethnic groups. The two most common indications for neurosurgical intervention were hemorrhage (49%) and hydrocephalus (48%), followed by trauma (18%), and brain tumor (11%). The top three neurological signs and symptoms reported were headache (48%), changes in mental status (41%), and nausea/vomiting (39%), followed by focal neurological deficits (33%), neck stiffness (19%), seizures (10%), and photophobia (6%). Nearly three quarters of patients (71%) were admitted to the ICU and 43% received mechanical ventilation for a median of 9 days.
A positive cerebrospinal fluid culture was observed in 106 patients (49%), with the majority of the etiologies being Staphylococcus and Gram-negative rods. An adverse clinical outcome occurred in 167 patients (78%) and was defined as death in 20 patients (9%), persistent vegetative state in 31 patients (14%), severe disability in 77 patients (36%), and moderate disability in 39 patients (18%).
Baseline variables associated with adverse clinical outcomes included age 45 years or older (odds ratio, 11.39), CNS bleeding (OR, 4.37), abnormal neurological exam (OR, 6.51), ICU admission (OR, 5.81), and use of mechanical ventilation (OR, 12.59; P less than .001 for all comparisons). Use of a ventriculoperitoneal shunt was found to be a protective variable (OR, 0.17), which, Dr. Srihawan said, could be explained by the fact most patients who received a ventriculoperitoneal shunt were children who had fewer comorbidities “and tended to be less sick.”
After logistic regression, only three variables remained significantly associated with adverse clinical outcomes: age 45 years or older (OR, 6.47), abnormal neurological exam (OR, 3.04), and use of mechanical ventilation (OR, 5.34).
IDWeek marks the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society. The researchers reported having no financial disclosures.