Cargando…

892. Meningitis after Ventricular Shunt Operations: Multicenter Study to Identify Etiology, Incidence and Risk Factors

BACKGROUND: A Ventriculoperitoneal shunt is the main treatment for communicating hydrocephalus. Surgical site infection associated with the shunt device is the most common complication and an expressive cause of morbidity and mortality of the treatment. The objective of our study is to answer three...

Descripción completa

Detalles Bibliográficos
Autores principales: Giarola, Lucca G, de Carvalho, Handerson Dias Duarte, Couto, Braulio Roberto Gonçalves Marinho, Starling, Carlos Ernesto Ferreira
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7776083/
http://dx.doi.org/10.1093/ofid/ofaa439.1080
_version_ 1783630598487670784
author Giarola, Lucca G
de Carvalho, Handerson Dias Duarte
Couto, Braulio Roberto Gonçalves Marinho
Starling, Carlos Ernesto Ferreira
author_facet Giarola, Lucca G
de Carvalho, Handerson Dias Duarte
Couto, Braulio Roberto Gonçalves Marinho
Starling, Carlos Ernesto Ferreira
author_sort Giarola, Lucca G
collection PubMed
description BACKGROUND: A Ventriculoperitoneal shunt is the main treatment for communicating hydrocephalus. Surgical site infection associated with the shunt device is the most common complication and an expressive cause of morbidity and mortality of the treatment. The objective of our study is to answer three questions: a)What is the risk of meningitis after ventricular shunt operations? b) What are the risk factors for meningitis? c) What are the main microorganisms causing meningitis? METHODS: A retrospective cohort study assessed meningitis and risk factors in patients undergoing ventricular shunt operations between 2015/Jul and 2018/Jun from 12 hospitals at Belo Horizonte, Brazil. Data were gathered by standardized methods defined by the National Healthcare Safety Network (NHSN)/CDC procedure-associated protocols for routine SSI surveillance. Sample size = 926. 26 variables were evaluated by univariate and multivariate analysis (logistic regression). RESULTS: 71 patients were diagnosed with meningitis which represent a risk of 7.7% (C.I.95%= 6.1%; 9.6%). From the 26 variables, three were acknoleged as risk factors: age < two years old (OR = 3.20; p < 0.001), preoperative hospital length of stay > four days (OR = 2.02; p = 0.007) and more than one surgical procedure (OR = 3.23; p = 0.043). Patients two or more years old, who had surgery four days after hospital admission, had increased risk of meningitis from 4% to 6% (p = 0.140). If a patient < two years had surgery four days post hospital admission, the risk is increased from 9% to 18% (p = 0.026). 71 meningitis = > 45 (63%) the etiologic agent identified: Staphylococcus aureus (33%), Staphylococcus epidermidis (22%), Acinetobacter sp (7%), Enterococcus sp (7%), Pseudomonas sp (7%), and other (18%). Hospital length of stay in non-infected patients (days): mean = 21 (sd = 28), median = 9; hospital stay in infected patients: mean = 34 (sd = 37), median = 27 (p=0.025). Mortality rate in patients without infection was 10% while hospital death of infected patients was 13% (p=0.544). CONCLUSION: Two intrinsic risk factors for meningitis post ventricular shunt, age under two years old and multiple surgeries, and one extrinsic risk factor, preoperative length of hospital stay, were identified. Incidence of meningitis post VP shunt decreases with urgent surgical treatment. DISCLOSURES: All Authors: No reported disclosures
format Online
Article
Text
id pubmed-7776083
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher Oxford University Press
record_format MEDLINE/PubMed
spelling pubmed-77760832021-01-07 892. Meningitis after Ventricular Shunt Operations: Multicenter Study to Identify Etiology, Incidence and Risk Factors Giarola, Lucca G de Carvalho, Handerson Dias Duarte Couto, Braulio Roberto Gonçalves Marinho Starling, Carlos Ernesto Ferreira Open Forum Infect Dis Poster Abstracts BACKGROUND: A Ventriculoperitoneal shunt is the main treatment for communicating hydrocephalus. Surgical site infection associated with the shunt device is the most common complication and an expressive cause of morbidity and mortality of the treatment. The objective of our study is to answer three questions: a)What is the risk of meningitis after ventricular shunt operations? b) What are the risk factors for meningitis? c) What are the main microorganisms causing meningitis? METHODS: A retrospective cohort study assessed meningitis and risk factors in patients undergoing ventricular shunt operations between 2015/Jul and 2018/Jun from 12 hospitals at Belo Horizonte, Brazil. Data were gathered by standardized methods defined by the National Healthcare Safety Network (NHSN)/CDC procedure-associated protocols for routine SSI surveillance. Sample size = 926. 26 variables were evaluated by univariate and multivariate analysis (logistic regression). RESULTS: 71 patients were diagnosed with meningitis which represent a risk of 7.7% (C.I.95%= 6.1%; 9.6%). From the 26 variables, three were acknoleged as risk factors: age < two years old (OR = 3.20; p < 0.001), preoperative hospital length of stay > four days (OR = 2.02; p = 0.007) and more than one surgical procedure (OR = 3.23; p = 0.043). Patients two or more years old, who had surgery four days after hospital admission, had increased risk of meningitis from 4% to 6% (p = 0.140). If a patient < two years had surgery four days post hospital admission, the risk is increased from 9% to 18% (p = 0.026). 71 meningitis = > 45 (63%) the etiologic agent identified: Staphylococcus aureus (33%), Staphylococcus epidermidis (22%), Acinetobacter sp (7%), Enterococcus sp (7%), Pseudomonas sp (7%), and other (18%). Hospital length of stay in non-infected patients (days): mean = 21 (sd = 28), median = 9; hospital stay in infected patients: mean = 34 (sd = 37), median = 27 (p=0.025). Mortality rate in patients without infection was 10% while hospital death of infected patients was 13% (p=0.544). CONCLUSION: Two intrinsic risk factors for meningitis post ventricular shunt, age under two years old and multiple surgeries, and one extrinsic risk factor, preoperative length of hospital stay, were identified. Incidence of meningitis post VP shunt decreases with urgent surgical treatment. DISCLOSURES: All Authors: No reported disclosures Oxford University Press 2020-12-31 /pmc/articles/PMC7776083/ http://dx.doi.org/10.1093/ofid/ofaa439.1080 Text en © The Author 2020. Published by Oxford University Press on behalf of Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Poster Abstracts
Giarola, Lucca G
de Carvalho, Handerson Dias Duarte
Couto, Braulio Roberto Gonçalves Marinho
Starling, Carlos Ernesto Ferreira
892. Meningitis after Ventricular Shunt Operations: Multicenter Study to Identify Etiology, Incidence and Risk Factors
title 892. Meningitis after Ventricular Shunt Operations: Multicenter Study to Identify Etiology, Incidence and Risk Factors
title_full 892. Meningitis after Ventricular Shunt Operations: Multicenter Study to Identify Etiology, Incidence and Risk Factors
title_fullStr 892. Meningitis after Ventricular Shunt Operations: Multicenter Study to Identify Etiology, Incidence and Risk Factors
title_full_unstemmed 892. Meningitis after Ventricular Shunt Operations: Multicenter Study to Identify Etiology, Incidence and Risk Factors
title_short 892. Meningitis after Ventricular Shunt Operations: Multicenter Study to Identify Etiology, Incidence and Risk Factors
title_sort 892. meningitis after ventricular shunt operations: multicenter study to identify etiology, incidence and risk factors
topic Poster Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7776083/
http://dx.doi.org/10.1093/ofid/ofaa439.1080
work_keys_str_mv AT giarolaluccag 892meningitisafterventricularshuntoperationsmulticenterstudytoidentifyetiologyincidenceandriskfactors
AT decarvalhohandersondiasduarte 892meningitisafterventricularshuntoperationsmulticenterstudytoidentifyetiologyincidenceandriskfactors
AT coutobrauliorobertogoncalvesmarinho 892meningitisafterventricularshuntoperationsmulticenterstudytoidentifyetiologyincidenceandriskfactors
AT starlingcarlosernestoferreira 892meningitisafterventricularshuntoperationsmulticenterstudytoidentifyetiologyincidenceandriskfactors