Glioma grade and post-neurosurgical meningitis risk.
Bacterial meningitis
Complication
Glioma surgery
Post-neurosurgical meningitis
Journal
Acta neurochirurgica
ISSN: 0942-0940
Titre abrégé: Acta Neurochir (Wien)
Pays: Austria
ID NLM: 0151000
Informations de publication
Date de publication:
18 Jul 2024
18 Jul 2024
Historique:
received:
29
04
2024
accepted:
07
07
2024
medline:
18
7
2024
pubmed:
18
7
2024
entrez:
18
7
2024
Statut:
epublish
Résumé
Post-neurosurgical meningitis (PNM) constitutes a grave complication associated with substantial morbidity and mortality. This study aimed to determine the risk factors predisposing patients to PNM following surgery for low- and high-grade gliomas. We conducted a retrospective analysis encompassing all patients who underwent glioma surgery involving craniotomy at Turku University Hospital, Turku, Finland, between 2011 and 2018. Inclusion criteria for PNM were defined as follows: (1) Positive cerebrospinal fluid (CSF) culture, (2) CSF leukocyte count ≥ 250 × 10 Among the 345 patients included in this study, PNM developed in 7% (n = 25) of cases. The median time interval between glioma surgery and diagnosis of PNM was 12 days. Positive CSF cultures were observed in 7 (28%) PNM cases, with identified pathogens encompassing Staphylococcus epidermidis (3), Staphylococcus aureus (2), Enterobacter cloacae (1), and Pseudomonas aeruginosa (1). The PNM group exhibited a higher incidence of reoperations (52% vs. 18%, p < 0.001) and revision surgery (40% vs. 6%, p < 0.001) in comparison to patients without PNM. Multivariable analysis revealed that reoperation (OR 2.63, 95% CI 1.04-6.67) and revision surgery (OR 7.08, 95% CI 2.55-19.70) were significantly associated with PNM, while glioma grade (high-grade vs. low-grade glioma, OR 0.81, 95% CI 0.30-2.22) showed no significant association. The PNM rate following glioma surgery was 7%. Patients requiring reoperation and revision surgery were at elevated risk for PNM. Glioma grade did not exhibit a direct link with PNM; however, the presence of low-grade gliomas may indirectly heighten the PNM risk through an increased likelihood of future reoperations. These findings underscore the importance of meticulous post-operative care and infection prevention measures in glioma surgeries.
Sections du résumé
BACKGROUND
BACKGROUND
Post-neurosurgical meningitis (PNM) constitutes a grave complication associated with substantial morbidity and mortality. This study aimed to determine the risk factors predisposing patients to PNM following surgery for low- and high-grade gliomas.
METHODS
METHODS
We conducted a retrospective analysis encompassing all patients who underwent glioma surgery involving craniotomy at Turku University Hospital, Turku, Finland, between 2011 and 2018. Inclusion criteria for PNM were defined as follows: (1) Positive cerebrospinal fluid (CSF) culture, (2) CSF leukocyte count ≥ 250 × 10
RESULTS
RESULTS
Among the 345 patients included in this study, PNM developed in 7% (n = 25) of cases. The median time interval between glioma surgery and diagnosis of PNM was 12 days. Positive CSF cultures were observed in 7 (28%) PNM cases, with identified pathogens encompassing Staphylococcus epidermidis (3), Staphylococcus aureus (2), Enterobacter cloacae (1), and Pseudomonas aeruginosa (1). The PNM group exhibited a higher incidence of reoperations (52% vs. 18%, p < 0.001) and revision surgery (40% vs. 6%, p < 0.001) in comparison to patients without PNM. Multivariable analysis revealed that reoperation (OR 2.63, 95% CI 1.04-6.67) and revision surgery (OR 7.08, 95% CI 2.55-19.70) were significantly associated with PNM, while glioma grade (high-grade vs. low-grade glioma, OR 0.81, 95% CI 0.30-2.22) showed no significant association.
CONCLUSIONS
CONCLUSIONS
The PNM rate following glioma surgery was 7%. Patients requiring reoperation and revision surgery were at elevated risk for PNM. Glioma grade did not exhibit a direct link with PNM; however, the presence of low-grade gliomas may indirectly heighten the PNM risk through an increased likelihood of future reoperations. These findings underscore the importance of meticulous post-operative care and infection prevention measures in glioma surgeries.
Identifiants
pubmed: 39023552
doi: 10.1007/s00701-024-06193-w
pii: 10.1007/s00701-024-06193-w
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
300Informations de copyright
© 2024. The Author(s).
Références
Aghi MK, Batchelor TT, Louis DN, Barker FG, Curry WT (2009) Decreased rate of infection in glioblastoma patients with allelic loss of chromosome 10q. J Neurooncol 93:115–120
doi: 10.1007/s11060-009-9826-3
pubmed: 19430887
Bohman LE, Gallardo J, Hankinson TC, Waziri AE, Mandigo CE, McKhann GM 2nd, Sisti MB, Canoll P, Bruce JN (2009) The survival impact of postoperative infection in patients with glioblastoma multiforme. Neurosurgery 64:828–834
doi: 10.1227/01.NEU.0000343525.89321.C5
pubmed: 19404146
Bracci PM, Rice T, Hansen HM, Francis SS, Lee S, McCoy LS, Shrestha PP, Warrier G, Clarke JL, Molinaro AM, Taylor JW, Wiencke JK, Wrensch MR (2022) Pre-surgery immune profiles of adult glioma patients. J Neurooncol 159(1):103–115
doi: 10.1007/s11060-022-04047-y
pubmed: 35716311
pmcid: 9325836
Cao Y, Pu K, Li G, Yan X, Ma Y, Xue K, Sun Z, Li Q (2017) The role of antibiotic prophylaxis in clean neurosurgery. World Neurosurg 100:305–310
doi: 10.1016/j.wneu.2016.12.108
pubmed: 28104524
Charoenkwan K, Chotirosniramit N, Rerkasem K (2012) Scalpel versus electrosurgery for abdominal incisions. Cochrane Database Syst Rev (6):CD005987. Update in: Cochrane Database Syst Rev 6:CD005987
Chen C, Zhang B, Yu S, Sun F, Ruan Q, Zhang W, Shao L, Chen S (2014) The incidence and risk factors of meningitis after major craniotomy in China: a retrospective cohort study. PLoS One 9:e101961
doi: 10.1371/journal.pone.0101961
pubmed: 25003204
pmcid: 4087000
Chen CH, Chang CY, Lin LJ, Chen WL, Chang YJ, Wang SH, Cheng CY, Yen HC (2016) Risk factors associated with postcraniotomy meningitis: A retrospective study. Medicine (Baltimore) 95:e4329
doi: 10.1097/MD.0000000000004329
pubmed: 27495035
Chen Y-R, Ugiliweneza B, Burton E, Woo SY, Boakye M, Skirboll S (2017) The effect of postoperative infection on survival in patients with glioblastoma. J Neurosurg 127:807–811
doi: 10.3171/2016.8.JNS16836
pubmed: 27935360
Corless CE, Guiver M, Borrow R, Edwards-Jones V, Fox AJ, Kaczmarski EB (2001) Simultaneous detection of Neisseria meningitidis, Haemophilus influenzae, and Streptococcus pneumoniae in suspected cases of meningitis and septicemia using real-time PCR. J Clin Microbiol 39:1553–1558
doi: 10.1128/JCM.39.4.1553-1558.2001
pubmed: 11283086
pmcid: 87969
CorsiniCampioli C, Challener D, Comba IY, Shah A, Wilson WR, Sohail MR, Van Gompel JJ, O’Horo JC (2022) Overview and risk factors for postcraniotomy surgical site infection: A four-year experience. Antimicrob Steward Healthc Epidemiol 2(1):e14
doi: 10.1017/ash.2021.258
Dashti SR, Baharvahdat H, Spetzler RF, Sauvageau E, Chang SW, Stiefel MF, Park MS, Bambakidis NC (2008) Operative intracranial infection following craniotomy. Neurosurg Focus 24:E10
doi: 10.3171/FOC/2008/24/6/E10
pubmed: 18518740
De Bonis P, Albanese A, Lofrese G, de Waure C, Mangiola A, Pettorini BL, Pompucci A, Balducci M, Fiorentino A, Lauriola L, Anile C, Maira G (2011) Postoperative infection may influence survival in patients with glioblastoma: simply a myth? Neurosurgery 69:864–868
doi: 10.1227/NEU.0b013e318222adfa
pubmed: 21900810
Dickinson H, Carico C, Nuño M, Mukherjee D, Ortega A, Black KL, Patil CG (2015) Unplanned readmissions and survival following brain tumor surgery. J Neurosurg 122:61–68
doi: 10.3171/2014.8.JNS1498
pubmed: 25343184
Grabowski MM, Sankey EW, Ryan KJ, Chongsathidkiet P, Lorrey SJ, Wilkinson DS, Fecci PE (2021) Immune suppression in gliomas. J Neurooncol 151(1):3–12
doi: 10.1007/s11060-020-03483-y
pubmed: 32542437
Hernández Ortiz OH, GarcíaGarcía HI, Muñoz Ramírez F, Cardona Flórez JS, Gil Valencia BA, Medina Mantilla SE, Moreno Ochoa MJ, Sará Ochoa JE, Jaimes F (2018) Development of a prediction rule for diagnosing postoperative meningitis: a cross-sectional study. J Neurosurg 128:262–271
doi: 10.3171/2016.10.JNS16379
pubmed: 28298047
Hussein K, Bitterman R, Shofty B, Paul M, Neuberger A (2017) Management of post-neurosurgical meningitis: narrative review. Clin Microbiol Infect 23:621–628
doi: 10.1016/j.cmi.2017.05.013
pubmed: 28529027
Jackson C, Westphal M, Quiñones-Hinojosa A (2016) Complications of glioma surgery. Handb Clin Neurol 134:201–218
doi: 10.1016/B978-0-12-802997-8.00012-8
pubmed: 26948356
Kim BN, Peleg AY, Lodise TP, Lipman J, Li J, Nation R, Paterson DL (2009) Management of meningitis due to antibiotic-resistant Acinetobacter species. Lancet Infect Dis 9:245–255
doi: 10.1016/S1473-3099(09)70055-6
pubmed: 19324297
pmcid: 2760093
Korinek AM, Baugnon T, Golmard JL, van Effenterre R, Coriat P, Puybasset L (2008) Risk factors for adult nosocomial meningitis after craniotomy: role of antibiotic prophylaxis. Neurosurgery 62(2):532–539
pubmed: 18596451
Kourbeti IS, Vakis AF, Ziakas P, Karabetsos D, Potolidis E, Christou S, Samonis G (2015) Infections in patients undergoing craniotomy: risk factors associated with post-craniotomy meningitis. J Neurosurg 122:1113–1119
doi: 10.3171/2014.8.JNS132557
pubmed: 25343179
Krenzlin H, Jankovic D, Alberter C, Kalasauskas D, Westphalen C, Ringel F, Keric N (2021) Frailty in glioblastoma is independent from chronological age. Front Neurol 12:777120
doi: 10.3389/fneur.2021.777120
pubmed: 34917020
pmcid: 8669893
Kuwano A, Saito T, Nitta M, Tsuzuki S, Koriyama S, Tamura M, Ikuta S, Masamune K, Muragaki Y, Kawamata T (2023) Relationship between characteristics of glioma treatment and surgical site infections. Acta Neurochir (Wien) 165:659–666
doi: 10.1007/s00701-022-05474-6
pubmed: 36585974
Leaper D, Ousey K (2015) Evidence update on prevention of surgical site infection. Curr Opin Infect Dis 28(2):158–163
doi: 10.1097/QCO.0000000000000144
pubmed: 25692267
Morshed RA, Young JS, Gogos AJ, Haddad AF, McMahon JT, Molinaro AM, Sudhakar V, Al-Adli N, Hervey-Jumper SL, Berger MS (2022) Reducing complication rates for repeat craniotomies in glioma patients: a single-surgeon experience and comparison with the literature. Acta Neurochir (Wien) 164:405–417
doi: 10.1007/s00701-021-05067-9
pubmed: 34970702
Natukka T, Raitanen J, Haapasalo H, Auvinen A (2019) Incidence trends of adult malignant brain tumors in Finland, 1990–2016. Acta Oncol 58:990–996
doi: 10.1080/0284186X.2019.1603396
pubmed: 30985227
Niemelä S, Lempinen L, Löyttyniemi E, Oksi J, Jero J (2023) Bacterial meningitis in adults: a retrospective study among 148 patients in an 8-year period in a university hospital, Finland. BMC Infect Dis 23:45
doi: 10.1186/s12879-023-07999-2
pubmed: 36690945
pmcid: 9869503
Rasmussen BK, Hansen S, Laursen RJ, Kosteljanetz M, Schultz H, Nørgård BM, Guldberg R, Gradel KO (2017) Epidemiology of glioma: clinical characteristics, symptoms, and predictors of glioma patients grade I-IV in the the Danish Neuro-Oncology Registry. J Neurooncol 135:571–579
doi: 10.1007/s11060-017-2607-5
pubmed: 28861666
Ravikumar V, Ho AL, Pendhakar AV, Sussman ES, Chow KK, Li G (2017) The use of vancomycin powder for surgical prophylaxis following craniotomy. Neurosurgery 80:754–758
doi: 10.1093/neuros/nyw127
pubmed: 28327930
Reichert MCF, Medeiros EAS, Ferraz FAP (2002) Hospital-acquired meningitis in patients undergoing craniotomy: incidence, evolution, and risk factors. Am J Infect Control 30:158–164
doi: 10.1067/mic.2002.119925
pubmed: 11988710
Robinson CP, Busl KM (2019) Meningitis and encephalitis management in the ICU. Curr Opin Crit Care 25:423–429
doi: 10.1097/MCC.0000000000000640
pubmed: 31306182
Salle H, Deluche E, Couvé-Deacon E, Beaujeux AC, Pallud J, Roux A, Dagain A, de Barros A, Voirin J, Seizeur R, Belmabrouk H, Lemnos L, Emery E, Fotso MJ, Engelhardt J, Jecko V, Zemmoura I, Le Van T, Berhouma M, Cebula H, Peyre M, Preux PM, Caire F (2021) Surgical Site Infections after glioblastoma surgery: results of a multicentric retrospective study. Infection 49:267–275
doi: 10.1007/s15010-020-01534-0
pubmed: 33034890
Schaff LR, Mellinghoff IK (2023) Glioblastoma and other primary brain malignancies in adults: a review. JAMA 329:574–587
doi: 10.1001/jama.2023.0023
pubmed: 36809318
Tian R, Hao S, Hou Z, Gao Z, Liu B (2015) The characteristics of post-neurosurgical bacterial meningitis in elective neurosurgery in 2012: A single institute study. Clin Neurol Neurosurg 139:41–45
doi: 10.1016/j.clineuro.2015.09.002
pubmed: 26364156
Valdoleiros SR, Torrão C, Freitas LS, Mano D, Gonçalves C, Teixeira C (2022) Nosocomial meningitis in intensive care: a 10-year retrospective study and literature review. Acute Crit Care 37:61–70
doi: 10.4266/acc.2021.01151
pubmed: 35081705
pmcid: 8918708
Zhu J, Qiu X, Ji C, Wang F, Tao A, Chen L (2023) Frailty as a predictor of neurosurgical outcomes in brain tumor patients: A systematic review and meta-analysis. Front Psychiatry 14:1126123
doi: 10.3389/fpsyt.2023.1126123
pubmed: 36873196
pmcid: 9982160