Clinical features and risk factors for outcomes of postoperative bacterial meningitis in pediatric neurosurgery: a retrospective study from 2013 to 2023.

OBJECTIVE

To explore clinical and etiological features and in-hospital mortality risk factors of post-operative bacterial meningitis in children who have undergone neurosurgery.

METHOD: The main clinical manifestations were fever, disturbance of consciousness, and vomiting, with rare meningeal irritation signs. Gram-positive bacteria caused 53.4% of episodes and Gram-negative bacteria 46.6%, with the latter having a higher incidence of infections within 1 month postoperatively. The overall in-hospital mortality rate was 6.8%, and 85.7% of non-survivors had Gram-negative infections. Pulmonary infection, mechanical ventilation duration ≥7 days, and GCS score ≤8 were correlated with mortality (all P < 0.05).

RESULTS

A total of 99 children (103 infection episodes) were included. A retrospective study was conducted at Children's Hospital of Fudan University from 2013 to 2023. Clinical, etiological, and prognostic data were collected, with patients grouped by CSF culture results and prognosis. Differences between groups were analyzed using t-test, Wilcoxon rank-sum test, Chi-Square test, or Fisher's exact test. Kaplan-Meier survival curves and Log-rank test were used for survival analysis, and Cox regression identified factors associated with in-hospital mortality.

CONCLUSIONS

Postoperative bacterial meningitis in children who have undergone neurosurgery has atypical clinical manifestations. Gram-positive bacteria are the main pathogens, but Gram-negative bacteria predominate in early postoperative infections (within 1 month), with Acinetobacter baumannii accounting for 45.8% and showing high carbapenem resistance. Pulmonary infection, mechanical ventilation duration ≥7 days, and GCS score ≤8 are associated with in-hospital mortality, necessitating early identification and intervention.