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

Objective: To explore the clinical characteristics of post-neurosurgical meningitis (PNM) patients infected with nonfermenting Gramnegative 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.

Automated summary

This study included 2940 PNM patients, of whom 207 (17.1%) were infected with NFGNB. The top three NFGNBs were Acinetobacter baumannii (105 cases, 50.7%), Pseudomonas aeruginosa (29 cases, 14.0%), and Acinetobacter lwoffii (20 cases, 9.7%). Hypertension, EVD, and AMV were independent risk factors for mortality.