Longitudinal Analysis of Risk Factors for Clinical Outcomes of Enterobacteriaceae Meningitis/Encephalitis in Post-Neurosurgical Patients: A Comparative Cohort Study During 2014–2019

Figures & data

Figure 1 Species found in Enterobacteriaceae related meningitis/encephalitis during 2014–2019.

Figure 2 Antimicrobial susceptibility tests of species found in Enterobacteriaceae related meningitis/encephalitis during 2014–2019.

Table 1 Comparison of the Factors of the Non-Survivor Group versus the Survivor Group. (Data are Presented as Number (%) of Patients, Mean ± SD, or Median [IQR] Unless Indicated Otherwise)

Factors	Total (n=164)	Non-Survivor (n=38)	Survivor (n=126)	P
Age (years)	40.1±15.4	42.0±16.9	39.5±15.0	0.518
Male (%)	94 (57.3%)	20 (52.7%)	74 (58.7%)	0.505
Comorbidities
Diabetes mellitus	4 (2.4%)	3 (7.9%)	1 (0.8%)	0.013
Hypertension	16 (9.8%)	8 (2.1%)	8 (6.3%)	0.007
Primary pathology
Tumor	72 (43.9%)	12 (31.6%)	60 (47.6%)	0.081
Trauma	3 (1.8%)	0 (0.0%)	3 (2.4%)	0.337
Tuberculosis	2 (1.2%)	0 (0.0%)	2 (1.2%)	0.435
Hepatitis B	4 (2.4%)	1 (2.6%)	3 (2.4%)	0.93
GCS Score	7.7±3.8	5.8±3.8	8.6±3.5	0.021
Time from procedure to infection, days	6 [2.5–13.5]	13.5 [8–16.8]	6 [2.0–12.0]	0.084
LOS, days	26.5 [20.0–40.0]	29.5 [19.3–42.0]	26 [20.0–39.8]	0.665
Sepsis	31 (18.9%)	17 (44.7%)	14 (11.1%)	P<0.001
ICU admission	61 (37.2%)	27 (71.1%)	34 (27%)	P<0.001
Producing ESBLs	62 (37.8%)	20 (52.6%)	42 (33.3%)	0.032
Surgical wound classification
Clean	68 (41.5%)	17 (44.7%)	51 (40.5%)	0.640
Clean-contaminated	96 (58.5%)	21 (55.3%)	75 (59.5%)	0.640
EVD	67 (40.9%)	19 (50.0%)	48 (38.1%)	0.191
LD	92 (56.1%)	23 (60.5%)	69 (42.1%)	0.530
Ventilator	42 (25.6%)	21 (55.3%)	21(16.7%)	P<0.001
CSF leakage	36 (22.0%)	8 (21.1%)	28 (22.2%)	0.879
Craniotomy	89 (54.3%)	25 (65.8%)	64 (50.8%)	0.104

Abbreviations: GCS, Glasgow Coma Scale; LOS, length of hospital stay; ICU, intensive care unit; ESBLs, extended-spectrum beta-lactamase; EVD, extra ventricular drainage; LD, lumbar drainage; CSF, cerebrospinal fluid.

Figure 3 Flowchart of the included patients with post-neurosurgical Enterobacteriaceae meningitis/encephalitis.

Abbreviations: MOF, multiple organ failure; ARDS, acute respiratory distress syndrome.

Table 2 Antibiotic Therapy and Clinical Outcomes of Patients with Post-Neurosurgical Enterobacteriaceae Meningitis/Encephalitis

Factors	Total (n=164)	Non-Survivor (n=38)	Survivor (n=126)	P
Antibiotic prophylaxis	148 (90.2%)	32 (84.2%)	116 (92.1%)	0.153
Ceftriaxone	39 (23.8%)	8 (21.1%)	31 (24.6%)	0.652
Ceftazidime	15 (9.1%)	3 (7.9%)	12 (9.5%)	0.76
Cefuroxime	51 (31.1%)	7 (18.4%)	44 (34.9%)	0.054
Meropenem	28 (17.1%)	8 (21.1%)	20 (15.9%)	0.457
Vancomycin	15 (9.1%)	6 (15.8%)	9 (7.1%)	0.105
Cefoperazone/Sulbactam	2 (1.2%)	0 (0.0%)	2 (1.6%)	0.435
Received empirical antibiotics	131 (79.9%)	32 (84.2%)	99 (78.6%)	0.447
Single antibiotics	26 (15.9%)	5 (13.2%)	21 (16.7%)	0.689
Ceftazidime	3 (1.8%)	0 (0.0%)	3 (2.4%)	0.337
Meropenem	17 (10.4%)	3 (7.9%)	14 (11.1%)	0.569
Cefuroxime	2 (1.2%)	0 (0.0%)	2 (1.6%)	0.435
Vancomycin	3 (1.8%)	1 (2.6%)	2 (1.6%)	0.674
Polymyxin	1 (0.6%)	1 (2.6%)	0 (0.0%)	0.068
Combination two antibiotics	90 (54.9%)	20 (12.2%)	60 (47.6%)	0.588
Vancomycin+Meropenem	75 (45.7%)	14 (8.5%)	61 (48.4%)	0.209
Meropenem+Ceftazidime	3 (1.8%)	1 (2.6%)	2 (1.6%)	0.674
Others	12 (7.3%)	5 (13.2%)	7 (5.6%)	0.115
Combination three antibiotics	15 (9.1%)	5 (13.2%)	10 (7.9%)	0.328
Vancomycin+Meropenem+Ceftazidime	12 (7.3%)	3 (7.9%)	9 (7.1%)	0.876
Others	3 (1.8%)	2 (5.3%)	1 (0.8%)	0.072
Received definitive therapy	137 (83.5%)	31 (81.6%)	106 (84.1%)	0.710
Single antibiotics	21 (12.8%)	2 (5.3%)	19 (15.1%)	0.112
Meropenem	19 (11.6%)	2 (5.3%)	17 (13.5%)	0.165
Vancomycin	2 (1.2%)	0 (0.0%)	2 (1.6%)	0.435
Combination two antibiotics	88 (53.7%)	15 (39.5%)	73 (57.9%)	0.673
Vancomycin+Meropenem	77 (47.0%)	14 (8.5%)	63 (50.0%)	0.154
Vancomycin+Ceftazidime	8 (4.9%)	1 (2.6%)	7 (5.6%)	0.463
Meropenem+Cefoperazone/Sulbactam	3 (1.8%)	0 (0.0%)	3 (2.4%)	0.337
Others	28 (17.1%)	8 (21.1%)	20 (15.9%)	0.457
Combination three antibiotics	14 (8.5%)	4 (10.5%)	10 (7.9%)	0.617
Meropenem+Vancomycin+Ceftazidime	6 (3.7%)	3 (7.9%)	3 (2.4%)	0.113
Meropenem+Ceftazidime+Tigecycline	5 (3.0%)	1 (2.6%)	4 (2.4%)	0.864
Others	3 (1.8%)	0 (0.0%)	3 (2.4%)	0.337

Table 3 Prognostic Risk Factors of Post-Neurosurgical Enterobacteriaceae Meningitis/Encephalitis Screened by Multivariate Cox Proportional Hazards Model

Factors	HR (95% CI)	P
Ventilation	1.209 (0.519–2.816)	0.660
Sepsis	1.281 (0.560–2.931)	0.557
Producing ESBLs	1.119 (0.483–2.592)	0.793
ICU admission	2.274 (0.832–6.215)	0.109
Comorbidities	1.594 (0.679–3.739)	0.284
GCS score≤8	2.588 (1.056–6.346)	0.038

Abbreviations: HR, hazard ratio; CI, confidence interval; ESBL, extended-spectrum beta-lactamase; ICU, intensive care unit; GCS, Glasgow Coma Scale.

Figure 4 Kaplan–Meier survival analyses for ventilation (A), sepsis (B), ICU (C), comorbidities (D), GCS score (≤8) (E), and producing ESBLs (F).

Abbreviations: ICU, intensive care unit; GCS, Glasgow Coma Scale; ESBL, extended-spectrum beta-lactamase.