1340. Healthcare-associated meningitis or ventriculitis: An analysis of 231 adult and pediatric patients
Session: Oral Abstract Session: CNS Infections
Saturday, October 10, 2015: 9:00 AM
Room: 7--AB
Background: Healthcare-associated meningitis or ventriculitis is a serious and life-threatening complication of invasive neurosurgical procedures or penetrating head trauma. Even though there are well-described methods to minimize the risk of post-operative infection, encourage early recognition and aggressive treatment, some of patients still have unfavorable outcomes. Methods: We included adult and pediatric patients with the diagnosis of healthcare-associated meningitis or ventriculitis as defined by the Centers of Diseases (CDC) case definition at two large tertiary care hospitals in Houston, Texas from July 2003 to November 2014. Patients were prospectively identified by infection control practitioners and by screening all the cerebrospinal fluid samples sent to the central laboratory. We collected data on demographics, clinical presentations, laboratory results, imaging studies, treatments and outcomes. Results: A total of 231 patients were included (142 adult and 91 pediatric cases). A positive cerebrospinal fluid culture was seen in 107 (46%) with the majority of the etiologies being staphylococcus and Gram-negative rods. An adverse clinical outcome was seen in 131 patients and was defined as death in 22 patients (9.5%), persistent vegetative state in 37 patients (16%), or severe disability in 71 patients (30.7%). Bivariate analysis identified a Glasgow coma scale (GCS)<15 (OR, 2.63; 95% CI, 1.31, 5.29; P = 0.006), acute focal neurological deficits (OR, 2.95; 95% CI, 1.22, 7.14; P = 0.014), and elevated CSF protein > 100 mg/dL (OR, 2.19 ; 95% CI 1.11-4.33;P = 0.023) to be associated with an adverse outcome. There were no significant differences for age, sex, comorbidities, CSF cell count, lactic acid levels, or positive CSF culture. On logistic regression analysis, only a GCS <15 (Adjusted OR, 2.31; 95% CI, 1.02, 5.22; P = 0.044), and elevated CSF protein > 100 mg/dL (Adjusted OR, 2.54 ; 95% CI 1.18-5.47;P = 0.017) were associated with the outcome. Conclusion: Healthcare-associated meningitis or ventriculitis continues to occur in our hospitals despite well established preventive methods and is associated with significant morbidity and mortality.
Chanunya Srihawan, MD1, Rodrigo Lopez, MD2, Lucrecia Salazar, MD3, Elizabeth Aguilera, MD4, Susan Wootton, MD1, Luis Ostrosky-Zeichner, FIDSA, FSHEA5 and Rodrigo Hasbun, MD, MPH6, (1)UT Health, Houston, TX, (2)Internal Medicine, University of Texas at Houston, Houston, TX, (3)Division of Infectious Diseases, University of Texas Medical School at Houston, Houston, TX, (4)Pediatrics, University of Texas Health Science Center, Houston, TX, (5)University of Texas, Houston, TX, (6)Infectious Diseases, University of Texas Health, Houston, TX

Disclosures:

C. Srihawan, None

R. Lopez, None

L. Salazar, None

E. Aguilera, None

S. Wootton, None

L. Ostrosky-Zeichner, None

R. Hasbun, Medicine''s Company: Speaker's Bureau , Speaker honorarium
Cubist: Speaker's Bureau , Speaker honorarium
Theravance: Speaker's Bureau , Speaker honorarium
Pfizer: Speaker's Bureau , Speaker honorarium

See more of: CNS Infections
See more of: Oral Abstract Session

Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.