Healthcare-associated meningitis or ventriculitis (HCAMV) is a serious and life-threatening complication of invasive neurosurgical procedures or penetrating head trauma. Older adults are at higher risk for adverse outcome in community-acquired meningitis but there are currently no studies evaluating HCAMV.
Retrospective study of adults with a diagnosis of HCAMV as defined by the 2015 Center of Disease Control and Prevention (CDC) case definition at a large tertiary care hospital in Houston, Texas from July 2003 to November 2014. Patients were classified as older adults if age ≥ 65 years, or younger adults if age 18-64 years. We collected data on demographics, clinical presentations, laboratory results, imaging studies, treatments and outcomes.
A total of 160 adult patients were included in the study; 18 patients (11.3%) were older adults. A positive cerebrospinal fluid (CSF) culture was observed in 79 patients (48%). Staphylococcus and Gram-negative rods were the two most common organisms isolated similar to the previous studies. Older adults were found to have higher rates of comorbidities, abnormal neurological exam, and CSF abnormalities [higher CSF protein level and lower CSF glucose level] (P<0.05).
An adverse clinical outcome was seen in 142 patients (88.8%); which was defined as death in 18 patients (12.7%), persistent vegetative state in 26 patients (18.3%), severe disability in 68 patients (47.9%), and moderate disability in 30 patients (21.1%). There was no difference in outcomes between older adults (97%) and younger adults (86.4%), P= 0.075. On logistic regression analysis, abnormal neurological exam (Adjusted OR, 7.13; 95% CI, 2.15, 23.63; P = 0.001), and mechanical ventilation (Adjusted OR, 11.03; 95% CI 1.35, 90.51; P = 0.025) were associated with an adverse clinical outcome.
Healthcare-associated meningitis or ventriculitis is associated with significant morbidity and mortality in both older and younger adults.
L. Salazar, None
R. Hasbun, None