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Abstract Details

Infectious Causes of Chronic Meningitis Among Neurosurgical Patients
Infectious Disease
S28 - Infectious Disease: Chronic Meningitis and the Immunosuppressed (1:24 PM-1:36 PM)
003
Chronic meningitis is an uncommon complication of neurosurgery. Some of the most common organisms shown to cause acute meningitis after neurosurgical procedures have been Staphylococcus, Klebsiella, Pseudomonas, and Candida species. Literature regarding chronic meningitis in this population is absent, although it has defined the clinical characteristics and etiologies of acute iatrogenic meningitis.
  • Describe the etiologies and mortality of chronic meningitis in neurosurgical patients

This is a retrospective chart review of all patients with chronic meningitis from 2002 to 2018.  Chronic meningitis which was defined the presence of CSF WBC pleocytosis greater than 5 cells/mm3 on two separate occasions at least 4 weeks apart. We manually extracted the data from the electronic medical record for identified case. The data collection and protocol were approved by the institution review board (IRB). 

25 patients were identified meet inclusion criteria for this period with an antecedent neurosurgical procedure. The age range of the patients was 20-84 years with mean of 54.3.  Most commonly CSF cultures were negative (24%), followed by Staphylococcus (20%), Pseudomonas (12%), and Candida (12%). Most common antecedent surgical procedures were craniotomy (48%), ventriculoperitoneal shunt placement/revision (20%), and extraventricular drain placed (16%). 30-day mortality was 12% (3/25).

Risk factors for post-surgical meningitis include increased age, craniotomy, and CSF leak. CSF leak and craniotomy were associated with the deaths in our series.  In patients with bacterial etiology, the majority (60%) were from gram-positive organisms, which correlates with current literature showing greater predominance of gram-positive organisms in these infections. Organisms grown in our patients were similar to previous studies on acute meningitis. Nearly half of our patients had craniotomy, suggesting this is a risk factor for chronic meningitis in addition to acute meningitis. Our data demonstrate a lower mortality (12%) in neurosurgical chronic meningitis than has been reported for acute neurosurgical meningitis (22%-36%).
Authors/Disclosures
Kelly Baldwin, MD (Evangelical Community Hospital)
PRESENTER 		Dr. Baldwin has nothing to disclose.
John Herbst, DO (Allegheny Health Network Cancer Institute) Dr. Herbst has nothing to disclose.
Jose Rivera, MD No disclosure on file
Tyler Crissinger, MD (Maine Health) Dr. Crissinger has nothing to disclose.
Eunice H. Bae, MD (Geisinger) Dr. Bae has nothing to disclose.