Federico et al evaluated patients with nosocomial bacterial meningitis after neurosurgery. They identified risk factors which can help to identify patients who may benefit from more aggressive management. The authors are from Universita Cattolica S. Cuore in Rome.
Criteria for bacterial meningitis:
(1) fever with temperature > 37.5°C OR clinical signs of CNS infection (stiff neck, headache, altered mental status)
(2) cerebrospinal fluid white blood cell count > 100 per µL with > 50% neutrophils
(3) bacterial organism cultured from CSF
Risk factors for development of meningitis:
(1) duration of ventriculostomy with external drainage
(2) high and increasing value of APACHE III score (range from 0 to 299)
where:
• No cutoffs were given for APACHE III score. In the univariate analysis in Table II the APACHE III score for patients with meningitis was 39.7 +/- 2.1 vs 21.1 +/- 3.9 for those without. In the implementation will use an APACHE III >= 30 as high.
• In Table II the risk of meningitis on univariate analysis is associated with duration of external drainage > 10 days.
Risk factors for mortality associated with meningitis:
(1) low CSF glucose (< 1.66 mmol/L0
(2) increasing value of APACHE III score
(3) Gram-negative bacteria as cause
