Evaluation of Prevalence and Risk Factors of Post-Craniotomy ‎Meningitis in Non-Emergency Patients

Post-neurosurgical meningitis can lead to severe complications and high mortality rates. The incidence varies in different conditions. The aim of this retrospective study is to determine the risk factors, occurrence, and microbiological spectrum of meningitis in patients with non-emergency craniotomy.

The patients who underwent non-emergency craniotomy at Poursina Hospital from September 23, 2016 to September 22, 2017 were selected. Exclusion criteria included traumatic surgery, only burr holing, only stereotactic surgery, and only trans-sphenoidal surgery. The medical records of each patient were reviewed, information on risk factors was extracted, and then the patients were evaluated for meningitis.

Out of 140 patients in the study, 7 cases were identified as meningitides, with an occurrence rate of 5%. The risk of meningitis increased with the presence of preoperative hydrocephalus (p=0.001), the use of an EVD (external ventricular drain) (P=0.001), perioperative antibiotics (p=0.001) and a GCS (Glasgow Coma Scale) <12 (P=0.001). Three out of 7 patients with meningitis had positive cultures. The only isolated microorganism was Acinetobacter spp.

Even after non-emergency craniotomy, meningitis can be a major source of morbidity and mortality. Low levels of consciousness (GCS<12), perioperative antibiotics, the use of an EVD, and hydrocephalus carry significantly high risks of infection.  Therefore, early identification of the risk factors will help physicians possibly prevent meningitis after non-emergency craniotomy in their patients.