Intracranial malignant lesions correlate with the requirement for a long treatment course in postoperative central nervous system infection

Bacterial Meningitis among Intracranial Surgery Patients at a University Hospital in Northern India

Background

Cerebrospinal infections are the cause of poor prognosis among post-neurosurgery patients owing to delay in improvement of neurological functions, leading to increased length of hospital stay, proceeding to disability or death.

Methods and materials

This retrospective observational study was performed at a tertiary care center in Northern India, where all patients with bacterial cerebrospinal infections from July 2019 to July 2022 were evaluated for post-neurosurgery cerebrospinal shunt infections, and all demographic data and risk factors were extracted from the hospital information system (HIS).

Results

The study includes 150 (150/1986, 7.55%) culture-confirmed cases of bacterial meningitis out of 1986 cases of suspected bacterial meningitis patients. Ninety-six (96/150, 64.0%) post-neurosurgery patients with cerebrospinal fluid (CSF) leaks were managed using external ventricular drain (EVD) or ventriculoperitoneal (VP) shunt. Seventy-four (74/96, 77.08%) patients were managed only on EVD, whereas 22 (22/96, 22.92%) patients were managed only on VP shunt. Eighty-two (82/96, 85.4%) multidrug-resistant microorganisms (MDROs) were isolated and 70 (70/82, 85.36%) were gram-negative bacteria, of which 56 (56/74, 75.68%) gram-negative bacteria showed extended-spectrum beta-lactamase (ESBL)-producing character in those with an EVD, 14 (14/22, 63.63%) with a VP shunt. Among gram-negative bacteria, Acinetobacter baumannii showed high rates of resistance: 21 (21/23, 91.30%) and 8 (8/8, 100%) were ESBL-producing A. baumannii in patients managed on EVD and VP shunt, respectively.

Conclusion

This study determines the risk factors, the spectrum of pathogenic microorganisms, multidrug resistance, and the nature of intracranial lesions isolated among the patients who developed bacterial cerebrospinal infections in post-neurosurgery patients.

How to cite this article

Kar M, Jamwal A, Dubey A, Sahu C, Patel SS. Bacterial Meningitis among Intracranial Surgery Patients at a University Hospital in Northern India. Indian J Crit Care Med 2022;26(12):1244-1252.

Dynamic Curve Analysis of Indicators Related to Lumbar Cistern Drainage for Postoperative Meningitis

OBJECTIVE

To analyze the dynamic curve of cerebrospinal fluid (CSF)-related indices in cases of postoperative meningitis after selective craniotomy and to provide reference data for the clinical treatment with lumbar cistern drainage (LCD).

METHODS

We conducted a retrospective study of LCD placement in 51 patients. Primary outcomes measured included dynamic changes of body temperature before and after intervention and cerebrospinal fluid biochemical parameters over the course of 13 days of catheter placement. We also assessed the bivariate correlation between white blood cell (WBC) count changes, polykaryocyte percentage, body temperature, and daily cerebrospinal fluid drainage volume. Finally, we analyzed the effect of average daily drainage volume, antibiotic choice, and surgical site on WBC count change curves.

RESULTS

After LCD, there was a statistically significant difference (P < 0.01) between the WBC count before drainage and on the fourth day of drainage. There was a negative correlation between the change curve of the WBC count and the change curve of daily drainage volume (r = -0.56). When the daily drainage volume was 250-300 mL/day, the change curve pattern of the WBC count was consistent with the overall trend, and there was no significant difference in the curve of the WBC count between different surgical sites (P > 0.05).

CONCLUSIONS

The WBC count can decrease significantly by day 4 after drainage, and placement of the LCD for 6-7 days is ideal. An average drainage volume of 250-300 mL/day is safe and effective.

Anti-inflammatory potential of pyocyanin in LPS-stimulated murine macrophages

Context: Pyocyanin is a typical Pseudomonas aeruginosa virulence factor, a common Gram-negative rod responsible for a wide range of severe nosocomial infections. There is evidence indicating that pyocyanin has multiple biological activities, but little is known about anti-inflammatory properties. Objective: This study investigated pyocyanin effect on nitric oxide and cytokine production in lipopolysaccharide (LPS)-activated murine peritoneal macrophages. Materials and methods: Macrophages were incubated in the presence and absence of pyocyanin (1, 5, 10, 50, and 100 µM) with and without LPS (1 µg/mL). Nitric oxide production was determined by Griess reagent and tumor necrosis factor (TNF)-α and interleukin (IL)-1β production was assessed by enzyme-linked immunosorbent assay. In addition, pyocyanin effects on zymosan A-induced peritonitis in mice were evaluated. Results: Pyocyanin (5 and 10 µM) decreased nitric oxide, TNF-α, and IL-1β production independent of macrophage death. On the other hand, in vivo, pyocyanin (5 mg/kg) was not able to affect leukocyte migration into the site of inflammation. Discussion and conclusion: Thus, our findings suggest that pyocyanin exerts anti-inflammatory effects on murine peritoneal macrophages, downregulating nitric oxide, TNF-α, and IL-1β levels, which seems to be independent of cell migration. These effects may represent a mechanism of immune evasion; nevertheless more detailed studies should be performed to confirm this hypothesis.