Nosocomial meningitis can be a complication of intracranial hemorrhage. Both conditions can be associated with adverse clinical outcomes but the prognostic impact of the infectious complication is unknown.
A retrospective case control study of adult patients with intracranial hemorrhage admitted to Memorial Hermann hospital in Houston, Texas from 2003 to 2015. Cases were patients with intracranial hemorrhages with nosocomial meningitis as defined by a positive cerebrospinal fluid (CSF) culture. Controls were selected as patients with intracranial hemorrhage without evidence of nosocomial meningitis and a negative CSF culture. Cases and controls were matched by age, Glasgow Coma Score (GCS) and Apache II scores. An adverse clinical outcome was defined as a Glasgow outcome score of 1-4. Logistic regression analysis was performed to identify independent risk factors associated with an adverse clinical outcome.
A total of 103 patients with intracranial hemorrhage were included in this study; 58(56%) had nosocomial meningitis proven by positive cerebrospinal fluid cultures. An adverse clinical outcome was seen in 64 (62%) of the patients and was seen more frequently in patients with nosocomial meningitis [50(86%) vs 14(31%) (P<0.001)]. Cases and controls were appropriately matched by age, GCS and Apache II score (p>0.05). On logistic regression analysis, independent factors associated with an adverse outcome were nosocomial meningitis, a Charlson Comorbidity Index >1, a GCS <15, and mechanical ventilation (p <0.05). These values were subsequently validated by bootstrap analysis.
Nosocomial meningitis has a significant prognostic impact in adults with intracranial hemorrhage. Prevention and prompt recognition of this infectious complication is important.
R. Hasbun, None
L. Salazar, None