Intrathecal or intraventricular therapy for post-neurosurgical Gram-negative meningitis: Matched cohort study

B. Shofty, A. Neuberger, M. E. Naffaa, T. Binawi, T. Babitch, Z. H. Rappaport, M. Zaaroor, G. Sviri, M. Paul

Research output: Contribution to journalArticle

22 Scopus citations

Abstract

Gram-negative post-operative meningitis due to carbapenem-resistant bacteria (CR-GNPOM) is a dire complication of neurosurgical procedures. We performed a nested propensity-matched historical cohort study aimed at examining the possible benefit of intrathecal or intraventricular (IT/IV) antibiotic treatment for CR-GNPOM. We included consecutive adults with GNPOM in two centres between 2005 and 2014. Patients receiving combined systemic and IT/IV treatment were matched to patients receiving systemic treatment only. Matching was done based on the propensity of the patients to receive IT/IV treatment. We compared patient groups with 30-day mortality defined as the primary outcome. The cohort included 95 patients with GNPOM. Of them, 37 received IT/IV therapy in addition to systemic treatment (22 with colistin and 15 with amikacin), mostly as initial therapy, through indwelling cerebrospinal fluid drains. Variables associated with IT/IV therapy in the propensity score included no previous neurosurgery, time from admission to meningitis, presence of a urinary catheter and GNPOM caused by carbapenem-resistant Gram-negative bacteria. Following propensity matching, 23 patients given IT/IV therapy and 27 controls were analysed. Mortality was significantly lower with IT/IV therapy: 2/23 (8.7%) versus 9/27 (33.3%), propensity-adjusted OR 0.19, 95% CI 0.04-0.99. Death or neurological deterioration at 30 days, 14-day and in-hospital mortality were lower with IT/IV therapy (OR <0.4 for all) without statistically significant differences. Among patients discharged alive, those receiving IT/IV therapy did not experience more neurological deterioration. Serious adverse events with IT/IV therapy were not documented. Our results support the early use of IT antibiotic treatment for CR-GNPOM when a delivery method is available.

Original languageEnglish (US)
Pages (from-to)66-70
Number of pages5
JournalClinical Microbiology and Infection
Volume22
Issue number1
DOIs
StatePublished - Jan 1 2016

Keywords

  • Gram-negative
  • Intrathecal
  • Intraventricular
  • Meningitis
  • Neurosurgery

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

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