[Risk factors of nosocomial meningitis in neurological intensive care unit. Results of a five-year prospective study]

Analysis of risk factors of intracranial infection after microvascular decompression

Intracranial infection is one of the most common complications of microvascular decompression (MVD). However, the risk factors for intracranial infection after MVD remain unknown. The aim of this study was to identify the risk factors for the development of post-MVD intracranial infection and to provide a basis for the prevention and control of intracranial infection following MVD. The clinical data of 154 patients with cranial nerve diseases who underwent MVD from October 2010 to August 2024 were retrospectively analyzed. The risk factors of intracranial infection were subjected to univariate and multivariate analysis. Twenty-four cases of intracranial infection occurred in 154 patients in this study, for a total infection rate of 15.6%. Univariate analysis showed that gender, duration of operation, CSF leakage, mastoid air cells breach, implants and intra-operative use of antibiotics were the risk factors related to intracranial infection after MVD (P < 0.05). Multivariate logistic regression analysis showed that a duration of operation and mastoid air cells breach were independent risk factors of intracranial infection after MVD (P < 0.05). The ROC curve analysis revealed that duration of operation, mastoid air cells breach and combined prediction exhibited area under the curve (AUC) values of 0.675 (95% CI [0.562-0.788]), 0.713 (95% CI [0.586-0.840]), 0.807 (95% CI [0.712-0.903]), respectively, for predicting intracranial infection after MVD. Duration of operation and mastoid air cells breach were independent risk factors for postoperative intracranial infection after MVD. The combination of two factors has high value in predicting the risk of intracranial infection following MVD.

[Nosocomial meningitis in endoscopic transsphenoidal surgery]

One of the main problems of transsphenoidal surgery is the risk of infectious complications. Nosocomial meningitis (NCM) can lead to increased length of hospital stay and financial costs, poor treatment outcomes and even mortality. This complication is an indicator of the quality of medical care for patients with neurosurgical diseases. The purpose of the review was to study the main risk factors of NCM, modern schemes for antibiotic prophylaxis and treatment of this complication after endoscopic transsphenoidal surgery. The main risk factors of meningitis are intra- and postoperative CSF leakage, overweight, diabetes mellitus, previous transsphenoidal surgeries and radiotherapy. To date, there are no generally accepted periods for antibiotic prophylaxis in nasal CSF leakage, installed external ventricular / lumbar drains or tampons in nasal cavity. Antibiotic prophylaxis should not exceed 3 postoperative days due to the risk of cultivating the drug-resistant organisms. If NCM is detected, treatment should be initiated immediately with a broad spectrum of antibiotics.