Clinical and microbiological characteristics and outcome of patients with healthcare associated ventriculitis and meningitis at a Public Sector Hospital in Pakistan

Nazish Arshad; Saima Samad; Sughand Memon; Sadia Ishaque; Shehla Baqi

doi:10.61529/idjp.v33i3.316

Authors

Nazish Arshad Shaheed Mohtarma Benazir Bhutto Institute of Trauma, Karachi Pakistan
Saima Samad Shaheed Mohtarma Benazir Bhutto Institute of Trauma, Karachi Pakistan
Sughand Memon Shaheed Mohtarma Benazir Bhutto Institute of Trauma, Karachi Pakistan
Sadia Ishaque Shaheed Mohtarma Benazir Bhutto Institute of Trauma, Karachi Pakistan
Shehla Baqi Bronxcare Health Systems New York, United States of America

DOI:

https://doi.org/10.61529/idjp.v33i3.316

Abstract

Background: Healthcare-associated meningitis and ventriculitis (HAVM) is a serious complication of placement of ventriculoperitoneal shunt (VPS) and external ventricular device (EVD), and can incur high morbidity and mortality.

Material And Methods: This retrospective descriptive, single center study was conducted in patients who had placement of VPS or EVD between January 2018 and December 2021 and developed HAVM. A list of these patients was retrieved from records maintained by the neurosurgery department.

Results: Thirty patients with HAVM were included. Median age was 8.5(IQR 22.25-0.75), two thirds were pediatric, 50% were males. Indication for device placement was congenital hydrocephalus in 18 (60%), tumor in 6 (20%) with VPS insertion in 25 (83.3%), EVD in 5 (16.7%). Fever was documented in 29 (96.7%). Cerebrospinal fluid analysis (CSF) demonstrated median pleocytosis with IQR of 93.5 (17-12959), protein of 131 (IQR 2-285), glucose of 24.5 (IQR 0-72). 17 (56.6%) had ICU stay, 11 were on mechanical ventilation. Mortality occurred in 4 (13.3%). CSF cultures were positive in 28 (93%) patients. Of 32 bacterial isolates, 16 were gram positive and 16 gram negative. In 15 (93.7%) patients, gram negatives were resistant to carbapenems and included 7 (46.6%) Enterobacterales (CRE), 3 (20%) Pseudomonas aeruginosa and 5 (33.3%) Acinetobacter spp. They were treated with IV colistin and meropenem. Predictors of mortality were male sex and sepsis. (p ≤ 0.05).

Conclusion: Male sex and sepsis were found to be predictors of mortality in HAVM. Gram-negatives in CSF cultures of 15 (93.7%) patients were resistant to carbapenems and challenging to treat.

Keywords: Cerebrospinal fluid infection, Healthcare-associated meningitis and ventriculitis, Hydrocephalus management, Risk-factors, Shunt infections

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