Hospital-acquired meningitis in patients undergoing craniotomy: Incidence, evolution, and risk factors

Objectives: To establish the incidence of postcraniotomy meningitis, identify etiologic agents, assess patientsʹ medical progress in relation to both length of hospitalization and mortality, and analyze risk factors. Material And Method: This study was developed at Hospital São Paulo, a tertiary university hospital, between August 1995 and January 1998. We conducted a case-control trial, in which 50 pairs of patients were matched. Results: An 8.9%-postcraniotomy meningitis incidence was found. Gram-negative bacilli were the most common etiologic agents isolated. Mortality among the patients was 30%. Mean hospital stay for the patients was 42.9 ± 22.1 days; for the controls, mean hospital stay was 19.0 ± 11.4 days (P = .00001). Although several risk factors were identified by univariate analysis, including postoperative external ventricular shunt (OR = 2.92, CI 95% = 1.245−6.865, P = .014), remote site infection (OR = 2.85, CI 95% = 0.995−8.173, P = .051), and repeat operation (OR = 5.02, CI 95% = 1.569−16.066, P = .007), only repeat operation remained in the multivariate analysis model (OR = 3.68, CI 95% = 1.158−11.700, P = .027). Conclusion: Postcraniotomy meningitis resulted in a high mortality rate and a longer hospital stay, with repeat operation identified among the risk factors. (Am J Infect Control 2002;30:158-64.)