Factors affecting in-hospital mortality and outcome study on healthcare-associated meningitis and/or ventriculitis (HCAMV): University of Malaya Medical Centre experience
Document Type
Article
Publication Date
6-1-2021
Abstract
Background & Objectives: Healthcare-associated Meningitis and/or Ventriculitis (HCAMV) is a serious yet frequent complication following neurosurgery. In this study, the clinical outcomes of HCAMV, risk factors associated with the clinical outcome, etiological agents and their corresponding antibiogram were investigated. Methods: All HCAMV patients treated in University Malaya Medical Centre (UMMC) from 2012-2017 were retrospectively reviewed. The inclusion criteria were 1) adult patient of 18 years of age and above, 2) positive CSF culture and 3) diagnosed as HCAMV after neurosurgical procedure. Patients' clinical data, etiological agents and the antibiogram of HCAMV were recorded. Patients were interviewed via phone to assess neurological deficit post-discharge. Clinical outcomes were Glasgow Coma Scale (GCS) during onset of HCAMV, patient's mortality, and post-discharge modified Rankin Scale (mRS). Results: Fifty two subjects were included in our study and male subjects predominated (65.4%, n=34) with the median age of 53 years old (range 20-75). Close to half of them had severe GCS (46.2%, n=24) and were intubated (48.1%, n=25). In regard to organisms recovered from the CSF, Gram-negative bacteria predominated (59.6%, n=31). Of these Acinetobacter baumannii was the commonest (38.5%, n=20) and carbapenem resistance was documented in 75% (n=15) of Acinetobacter baumannii. In-hospital mortality rate was 32.7% (n=17) and additional 20 subjects died within a year of HCAMV diagnosis. Multivariate analysis showed intubation associated with in-hospital mortality in this study (aOR, 0.3; P = 0.001). Conclusion: We reported a high percentage of HCAMV caused by carbapenem-resistant Acinetobacter baumannii and intubation is an independent risk factor for in-hospital mortality.
Keywords
Meningitis, Ventriculitis, Post neurosurgical infection, Carbapenem resistant, Acinetobacter baumannii
Divisions
fac_med
Funders
None
Publication Title
Neurology Asia
Volume
26
Issue
2
Publisher
ASEAN Neurological Association
Publisher Location
UNIV MALAYA MEDICAL CENTRE, NEUROLOGY LABORATORY, KUALA LUMPUR, 59100, MALAYSIA