Post-neurosurgical Meningitis
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Date
2025-08-30
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SCTIMST
Abstract
Post neurosurgical meningitis (PNM) is an organ space infection type of Surgical Site infection (SSI) and may be accompanied by Superficial or deep wound site infection. This can occur after Craniotomy, craniectomy or after External drainage device insertion. It is defined as an SSI only when it occurs within one month after the initial surgery or within one year after an implant is placed. The signs and symptoms are the same as for community acquired meningitis, but due to the surgery, signs like neck stiffness may be difficult to elicit .
The major risk factors for PNM are discussed along with three case studies.
Role of the laboratory:
Microbiology of PNM is discussed with common organisms that cause infection, both in literature and within the institute. Data from SCTIMST is discussed. A short discussion on Pharmaco kinetics and dynamics of antibiotics in the CSF, with optimum doses of all antibiotics used in meningitis.
Accurate biochemical values to monitor progression. Some of the biomarkers that can be monitored in serum and CSF are: Procalcitonin, Lactate, IL-2. However, the studies are still going on to fix the cut-off levels for these.
Prevention and surveillance: Surveillance of PNM is the integral part of any hospital infection control surveillance programme. Any increase in numbers or clustering of cases should be investigated
1. Adherence to Definition of SSI to be confirmed for each infection reported
2. Patient population selected
3. Any increase in pre-op stay
4. Eradication of any infection inother sites pre-operatively
5. Surgical antimicrobial prophylaxis to include antibiotics used to manage existing infective processes elsewhere.
6. SAP to be stopped in 48hrs.
7. No role for nasal Mupirocin established yet.
8. Standard Infection ratio is the new statistic being used.
9. Prudent use of antibiotics and standard infection control practices form the mainstay
Take home message:
1. Risk factors discussed to be avoided
2. Laboratory guidance for Antibiotic choice is essential. Intra-thecal approach and right knowledge of PK-PD
3. Surgical antimicrobial prophylaxis(SAP) only for 48hrs. For existing infection add the antibiotic as SAP
4. SIR is a new mode of expressing SSI based on risk stratification
5. Biomarkers in CSF are being studied for monitoring of progress.