Empirical Combination Antibiotic Therapy Improves the Outcome of Nosocomial Meningitis or Ventriculitis in Neuro-Critical Care Unit Patients

Abstract

Background: Nosocomial meningitis and ventriculitis (MEN) are serious complications in neuro-critical care unit (NCCU) patients. Few data are available on the risk factors and mortality rates among NCCU patients with these disorders caused by multi-drug-resistant (MDR) pathogens. Our aim was to identify the risk factors for MEN caused by such pathogens and in-hospital deaths in critically ill neurologic patients and to evaluate the impact of empirical combination antibiotic therapy (ECAT) on the outcomes of these patients.

Methods: We conducted a retrospective study of critically ill neurologic patients having nosocomial MEN who were admitted to the NCCU in a university teaching hospital from January 2003 to December 2013, with MEN being defined using the modified U.S. Centers for Disease Control and Prevention criteria for nosocomial infections.

Results: In total, 6,149 consecutive NCCU patients were screened; 132 had MEN. Logistic regression analysis demonstrated that MDR MEN was related to infection with gram-negative (GN) bacteria (odds ratio 3.16; 95% confidence interval [CI] 1.08-9.25; p = 0.036), and inadequate initial antibiotic therapy (odds ratio 9.80; 95% CI 3.79-25.32; p < 0.001). The ECAT was associated with a lower mortality rate (hazard ratio 0.35; 95% CI 0.14-0.86; p = 0.022) in Cox proportional hazard regression analysis. The other variable independently associated with a greater mortality rate was a greater Simplified Acute Physiology Score II (hazard ratio 1.07; 95% CI 1.01-1.13; p = 0.018).

Conclusions: Initial combination therapy improves the in-hospital mortality rate among NCCU patients with nosocomial MEN. Inadequate initial antibiotic therapy and GN infection were associated with MDR MEN.