Nomogram Analysis of Clinical Characteristics and Mortality Risk Factor of Non-Fermentative Gram-Negative Bacteria-Induced Post-Neurosurgical Meningitis

Abstract

Objective

To explore the clinical characteristics of post-neurosurgical meningitis (PNM) patients infected with nonfermenting Gram-negative bacilli (NFGNB) and to evaluate the related mortality risk factors.

Methods

A cohort analysis of PNM patients infected with NFGNB in Beijing Tiantan Hospital and Capital Medical University from 2012.1 to 2020.12. The microbial distribution, antimicrobial sensitivity and genotypes were tested, and potential mortality risk factors were evaluated using Mann–Whitney U or chi-squared tests. Independent risk factors for mortality were established by constructing a logistic model.

Results

A total of 2940 PNM patients were enrolled in this study, of whom 207 (17.1%) were infected with NFGNB. Among these patients, 29 died of NFGNB meningitis, with an overall mortality rate of 14.0%. The top three NFGNBs were Acinetobacter baumannii (105 cases, 50.7%), Pseudomonas aeruginosa (29 cases, 14.0%) and Acinetobacter lwoffii (20 cases, 9.7%). Nomogram analysis revealed that hypertension (OR 4.551, 95% CI: 1.464–14.154, P = 0.009), external ventricular drainage (EVD) (OR 3.944, 95% CI: 1.286–12.095, P = 0.016), and assisted mechanical ventilator (AMV) (OR 6.192, 95% CI: 1.737–22.081, P = 0.005) were independent risk factors for mortality. In addition, antibiotic prophylaxis was shown to play a vital role in NFGNB-induced PNM therapy.

Conclusion

PNM patients infected with NFGNB have a high mortality rate. Hypertension, EVD and AMV were independent mortality risk factors, and clinical attention should be paid to their prevention and treatment.

Keywords:

• clinical characteristics
• nomogram analysis
• meningitis
• mortality
• nonfermenting Gram-negative bacilli

Data Sharing Statement

The original contributions presented in the study are included in the article/Supplementary Material. Further inquiries can be directed to the corresponding authors.

Ethical Approval and Consent to Participate

The study was approved by the Ethical Committees of Beijing Tiantan Hospital & Capital Medical University (No. KY-2021-079-02) and the study complies with the Declaration of Helsinki. Each patient enrolled in the study signed an informed consent form.

Acknowledgments

The authors want to take this chance to thank Miss Yumeng Cai and for her help in drawing the figures.

Author Contributions

GHZ: design and drafting of the article; data collection and analysis and interpretation. SQW: statistics and genotypes test. HL and GJZ: conduct the whole study.

Disclosure

All of the authors declared that no conflict exists in this study.

Additional information

Funding

Beijing Hospital Authority Clinical Medicine Development of Special Funding [Grant No. ZYLX202108]; Beijing Municipal Administration of Hospitals Incubating Program [Grant No. PX2022021].