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Abstract：
BACKGROUND: Post-neurosurgical meningitis (PNM) constitutes a grave complication associated with substantial morbidity and mortality. This study aimed to determine the risk factors predisposing patients to PNM following surgery for low- and high-grade gliomas.
METHODS: We conducted a retrospective analysis encompassing all patients who underwent glioma surgery involving craniotomy at Turku University Hospital, Turku, Finland, between 2011 and 2018. Inclusion criteria for PNM were defined as follows: (1) Positive cerebrospinal fluid (CSF) culture, (2) CSF leukocyte count ≥ 250 × 106/L with granulocyte percentage ≥ 50%, or (3) CSF lactate concentration ≥ 4 mmol/L, detected after glioma surgery. Glioma grades 3-4 were classified as high-grade (n = 261), while grades 1-2 were designated as low-grade (n = 84).
RESULTS: Among the 345 patients included in this study, PNM developed in 7% (n = 25) of cases. The median time interval between glioma surgery and diagnosis of PNM was 12 days. Positive CSF cultures were observed in 7 (28%) PNM cases, with identified pathogens encompassing Staphylococcus epidermidis (3), Staphylococcus aureus (2), Enterobacter cloacae (1), and Pseudomonas aeruginosa (1). The PNM group exhibited a higher incidence of reoperations (52% vs. 18%, p < 0.001) and revision surgery (40% vs. 6%, p < 0.001) in comparison to patients without PNM. Multivariable analysis revealed that reoperation (OR 2.63, 95% CI 1.04-6.67) and revision surgery (OR 7.08, 95% CI 2.55-19.70) were significantly associated with PNM, while glioma grade (high-grade vs. low-grade glioma, OR 0.81, 95% CI 0.30-2.22) showed no significant association.
CONCLUSIONS: The PNM rate following glioma surgery was 7%. Patients requiring reoperation and revision surgery were at elevated risk for PNM. Glioma grade did not exhibit a direct link with PNM; however, the presence of low-grade gliomas may indirectly heighten the PNM risk through an increased likelihood of future reoperations. These findings underscore the importance of meticulous post-operative care and infection prevention measures in glioma surgeries.
METHODS: We conducted a retrospective analysis encompassing all patients who underwent glioma surgery involving craniotomy at Turku University Hospital, Turku, Finland, between 2011 and 2018. Inclusion criteria for PNM were defined as follows: (1) Positive cerebrospinal fluid (CSF) culture, (2) CSF leukocyte count ≥ 250 × 106/L with granulocyte percentage ≥ 50%, or (3) CSF lactate concentration ≥ 4 mmol/L, detected after glioma surgery. Glioma grades 3-4 were classified as high-grade (n = 261), while grades 1-2 were designated as low-grade (n = 84).
RESULTS: Among the 345 patients included in this study, PNM developed in 7% (n = 25) of cases. The median time interval between glioma surgery and diagnosis of PNM was 12 days. Positive CSF cultures were observed in 7 (28%) PNM cases, with identified pathogens encompassing Staphylococcus epidermidis (3), Staphylococcus aureus (2), Enterobacter cloacae (1), and Pseudomonas aeruginosa (1). The PNM group exhibited a higher incidence of reoperations (52% vs. 18%, p < 0.001) and revision surgery (40% vs. 6%, p < 0.001) in comparison to patients without PNM. Multivariable analysis revealed that reoperation (OR 2.63, 95% CI 1.04-6.67) and revision surgery (OR 7.08, 95% CI 2.55-19.70) were significantly associated with PNM, while glioma grade (high-grade vs. low-grade glioma, OR 0.81, 95% CI 0.30-2.22) showed no significant association.
CONCLUSIONS: The PNM rate following glioma surgery was 7%. Patients requiring reoperation and revision surgery were at elevated risk for PNM. Glioma grade did not exhibit a direct link with PNM; however, the presence of low-grade gliomas may indirectly heighten the PNM risk through an increased likelihood of future reoperations. These findings underscore the importance of meticulous post-operative care and infection prevention measures in glioma surgeries.
摘要：
背景：神经外科手术后脑膜炎（PNM）是一种严重的并发症，与大量的发病率和死亡率相关。这项研究旨在确定低级别和高级别神经胶质瘤手术后易患PNM的危险因素。
方法：我们进行了一项回顾性分析，包括在图尔库大学医院接受神经胶质瘤手术（包括开颅手术）的所有患者，图尔库,芬兰,2011年至2018年。PNM的纳入标准定义如下：（1）脑脊液（CSF）培养阳性，（2）脑脊液白细胞计数≥250×106/L，粒细胞百分比≥50%，或（3）脑脊液乳酸浓度≥4mmol/L，胶质瘤手术后检测到。胶质瘤3-4级被分类为高级别（n=261），而1-2级被指定为低等级(n=84)。
结果：在纳入本研究的345名患者中，PNM在7%(n=25)的病例中发展。胶质瘤手术与PNM诊断之间的中位时间间隔为12天。在7例（28%）PNM病例中观察到脑脊液培养阳性，已确定的病原体包括表皮葡萄球菌（3），金黄色葡萄球菌（2），阴沟肠杆菌(1),和铜绿假单胞菌(1)。PNM组的再手术发生率较高(52%vs.18%,p<0.001)和翻修手术(40%vs.6%,与没有PNM的患者相比，p<0.001）。多变量分析显示，再手术（OR2.63，95％CI1.04-6.67）和翻修手术（OR7.08，95％CI2.55-19.70）与PNM显着相关。而胶质瘤分级(高级别与低度胶质瘤,OR0.81，95%CI0.30-2.22)显示无显著相关性。
结论：神经胶质瘤手术后的PNM率为7%。需要再次手术和翻修手术的患者发生PNM的风险较高。胶质瘤分级与PNM没有直接联系；然而，低级别胶质瘤的存在可能通过增加未来再次手术的可能性而间接增加PNM风险.这些发现强调了神经胶质瘤手术中细致的术后护理和感染预防措施的重要性。
方法：我们进行了一项回顾性分析，包括在图尔库大学医院接受神经胶质瘤手术（包括开颅手术）的所有患者，图尔库,芬兰,2011年至2018年。PNM的纳入标准定义如下：（1）脑脊液（CSF）培养阳性，（2）脑脊液白细胞计数≥250×106/L，粒细胞百分比≥50%，或（3）脑脊液乳酸浓度≥4mmol/L，胶质瘤手术后检测到。胶质瘤3-4级被分类为高级别（n=261），而1-2级被指定为低等级(n=84)。
结果：在纳入本研究的345名患者中，PNM在7%(n=25)的病例中发展。胶质瘤手术与PNM诊断之间的中位时间间隔为12天。在7例（28%）PNM病例中观察到脑脊液培养阳性，已确定的病原体包括表皮葡萄球菌（3），金黄色葡萄球菌（2），阴沟肠杆菌(1),和铜绿假单胞菌(1)。PNM组的再手术发生率较高(52%vs.18%,p<0.001)和翻修手术(40%vs.6%,与没有PNM的患者相比，p<0.001）。多变量分析显示，再手术（OR2.63，95％CI1.04-6.67）和翻修手术（OR7.08，95％CI2.55-19.70）与PNM显着相关。而胶质瘤分级(高级别与低度胶质瘤,OR0.81，95%CI0.30-2.22)显示无显著相关性。
结论：神经胶质瘤手术后的PNM率为7%。需要再次手术和翻修手术的患者发生PNM的风险较高。胶质瘤分级与PNM没有直接联系；然而，低级别胶质瘤的存在可能通过增加未来再次手术的可能性而间接增加PNM风险.这些发现强调了神经胶质瘤手术中细致的术后护理和感染预防措施的重要性。
