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. 2025 Nov 11;13(1):63.
doi: 10.1186/s40560-025-00828-5.

Risk factors for nosocomial meningitis in patients with external ventricular drainages

Coline Raffenot  1 , Vincent Doat-Sarfati  2 , François Antonini  3 , Thibault Florant  4 , Sophie Baron  5 , Geoffray Agard  6 , Valérie Minetti  7 , Nicolas Bruder  1 , Salah Boussen  1 , Arthur Malet  1 , Sophie Cataldi  1 , Audrey Le Saux  8 , Marc Gainnier  8 , Julien Carvelli  8 , David Couret  9   10 , Lionel Velly  1   11 , Pierre Simeone  12   13
Affiliations

Risk factors for nosocomial meningitis in patients with external ventricular drainages

Coline Raffenot et al. J Intensive Care. .

Abstract

Background: External ventricular drain (EVD)-associated infections are a significant cause of morbidity and mortality. Nosocomial meningitis (NM) poses diagnostic challenges, and its prognosis heavily relies on the timely initiation of treatment. The aim of this study was to investigate the epidemiology of NM and risk factors in ICU patients.

Methods: We conducted a retrospective single-center cohort study of adult patients who received an EVD in a French ICU between 2018 and 2022. Patients were classified into those with NM or without meningitis based on biological and microbiological criteria. We assessed risk factors related to the patient, the device, and the primary pathology, treatment regimens, length of stay, and survival.

Results: Of 275 patients with EVD, 32 (11.6%) developed NM. Patients with meningitis had longer ICU stays (median 42.5 vs. 29 days; p = 0.019), though in-hospital mortality was similar between groups (29.5% vs. 21.9%; p = 0.668). A pathogen was identified in 75% of episodes. Significant risk factors associated with NM included CSF leakage at the insertion site (OR 3.47; 95% CI, 1.53-7.86; p = 0.002), longer drainage duration (OR 1.07 per day; 95% CI, 1.04-1.12; p < 0.001), β-lactam allergy (OR 6.83; 95% CI, 1.73-26.92; p = 0.002), and a cytochemical profile consistent with infection (leukocytes > 100/mm3, CSF-to-serum glucose ratio < 0.5, and protein > 1 g/) in the cerebrospinal fluid (OR 3.87; 95% CI 1.67-8.97; p < 0.001). We proposed a predictive model derived from these identified factors with an AUC-ROC curve of 0.89 (95% CI, 0.83-0.94) with a negative predictive value of 96.8%.

Conclusion: Key risk factors included β-lactam allergy, CSF leakage, prolonged drainage, and cerebrospinal biological profile. This predictive model, derived from these factors, could be used for the early detection and treatment of NM.

Keywords: External ventricular drain; ICU; Nosocomial meningitis; Outcomes; Predictive model.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: We confirm adherence to ethical guidelines and indicate ethical approvals (“Comité d’éthique pour la recherche en Anesthésie‐Réanimation”—IRB 00010254‐2024-115). Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Survival probability for patients with nosocomial meningitis (NM) and without nosocomial meningitis (NNM) at 3 years
Fig. 2
Fig. 2
Predictive Model for diagnosis of nosocomial meningitis. This model includes CSF Leakage, CSF/Serum Glucose Ratio <0.5, CSF Protein >1 g/L, EVD Duration, and β-Lactam Allergy. Sp = Specificity; Se = Sensitivity; NPV = Negative Predictive Value
See this image and copyright information in PMC

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