{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T17:15:32Z","timestamp":1793380532459,"version":"4.5.0"},"reference-count":31,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2022,6,3]],"date-time":"2022-06-03T00:00:00Z","timestamp":1654214400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Infectious Disease Reports"],"abstract":"<jats:p>Healthcare associated meningitis and ventriculitis (HCAMV) are serious complications of neurosurgical procedures. We conducted a retrospective cohort study of patients with HCAMV treated at the University Hospital for Infectious Diseases Zagreb during the 2013\u20132019 period. A total of 144 patients with 151 episodes of HCAMV were included. The most common indications for neurosurgical procedures were brain tumor, hemorrhage and hydrocephalus. Etiology was identified in 90 (59.6%) episodes (either positive CSF culture or positive PCR), and in other 61 (40.39%) the diagnosis of HCAMV was made based on clinical and CSF parameters, without microbiologic confirmation. Carbapenem-resistant Acinetobacter baumannii was the most common pathogen (15.89%), followed by Staphylococcus aureus (13.91%), Pseudomonas aeruginosa (13.25%) and Coagulase negative staphylococci (7.95%). Overall, 24 (16.3%) patients died, and the majority had adverse outcomes, persistent vegetative state (8, 5.56%) and severe disability (31, 21.53%). The worst clinical outcomes were observed in A. baumannii infections. High rate of complications, the need for external ventricular drainage (re)placement often complicated with nosocomial infections and prolonged stay in intensive care units were observed. Clinicians should be aware of local microbial epidemiology on guiding proper empirical antimicrobial treatment in patients with HCAMV.<\/jats:p>","DOI":"10.3390\/idr14030045","type":"journal-article","created":{"date-parts":[[2022,6,3]],"date-time":"2022-06-03T10:33:01Z","timestamp":1654252381000},"page":"420-427","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Etiology and Outcomes of Healthcare-Associated Meningitis and Ventriculitis\u2014A Single Center Cohort Study"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8214-4953","authenticated-orcid":false,"given":"Hana","family":"Panic","sequence":"first","affiliation":[{"name":"School of Medicine, University of Zagreb, \u0160alata 3b, 10000 Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Branimir","family":"Gjurasin","sequence":"additional","affiliation":[{"name":"Department for Adult Intensive Care and Neuroinfections, University Hospital for Infectious Diseases Zagreb, Mirogojska 8, 10000 Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marija","family":"Santini","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Zagreb, \u0160alata 3b, 10000 Zagreb, Croatia"},{"name":"Department for Adult Intensive Care and Neuroinfections, University Hospital for Infectious Diseases Zagreb, Mirogojska 8, 10000 Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marko","family":"Kutlesa","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Zagreb, \u0160alata 3b, 10000 Zagreb, Croatia"},{"name":"Department for Adult Intensive Care and Neuroinfections, University Hospital for Infectious Diseases Zagreb, Mirogojska 8, 10000 Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neven","family":"Papic","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Zagreb, \u0160alata 3b, 10000 Zagreb, Croatia"},{"name":"Department for Viral Hepatitis, University Hospital for Infectious Diseases Zagreb, Mirogojska 8, 10000 Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,6,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1056\/NEJMra0804573","article-title":"Nosocomial bacterial meningitis","volume":"362","author":"Drake","year":"2010","journal-title":"N. Engl. J. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1080\/02688690500145639","article-title":"Risk factors for neurosurgical site infections after craniotomy: A critical reappraisal of antibiotic prophylaxis on 4578 patients","volume":"19","author":"Korinek","year":"2005","journal-title":"Br. J. Neurosurg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1086\/518580","article-title":"Postoperative central nervous system infection: Incidence and associated factors in 2111 neurosurgical procedures","volume":"45","author":"McClelland","year":"2007","journal-title":"Clin. Infect. Dis."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Chen, C., Zhang, B., Yu, S., Sun, F., Ruan, Q., Zhang, W., Shao, L., and Chen, S. (2014). The incidence and risk factors of meningitis after major craniotomy in China: A retrospective cohort study. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0101961"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"29","DOI":"10.3906\/sag-1508-102","article-title":"Pooled analysis of 899 nosocomial meningitis episodes from Turkey","volume":"47","author":"Sipahi","year":"2017","journal-title":"Turk. J. Med. Sci."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"861","DOI":"10.1007\/s10096-013-2026-2","article-title":"Post-operative central nervous system infections after cranial surgery in China: Incidence, causative agents, and risk factors in 1470 patients","volume":"33","author":"Zhan","year":"2014","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e34","DOI":"10.1093\/cid\/ciw861","article-title":"2017 Infectious Diseases Society of America\u2019s Clinical Practice Guidelines for Healthcare-Associated Ventriculitis and Meningitis","volume":"64","author":"Tunkel","year":"2017","journal-title":"Clin. Infect. Dis."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1016\/j.nec.2017.11.008","article-title":"Nosocomial Infections in the Neurointensive Care Unit","volume":"29","author":"Busl","year":"2018","journal-title":"Neurosurg. Clin. N. Am."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"101","DOI":"10.3171\/jns.2006.104.1.101","article-title":"Lack of value of routine analysis of cerebrospinal fluid for prediction and diagnosis of external drainage-related bacterial meningitis","volume":"104","author":"Schade","year":"2006","journal-title":"J. Neurosurg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1555","DOI":"10.1086\/518169","article-title":"Evaluation of the management of postoperative aseptic meningitis","volume":"44","author":"Zarrouk","year":"2007","journal-title":"Clin. Infect. Dis."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1086\/588298","article-title":"Characteristics and treatment outcome of cerebrospinal fluid shunt-associated infections in adults: A retrospective analysis over an 11-year period","volume":"47","author":"Conen","year":"2008","journal-title":"Clin. Infect. Dis."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"433","DOI":"10.4103\/0028-3886.44629","article-title":"Clinical features, laboratory data, management and the risk factors that affect the mortality in patients with postoperative meningitis","volume":"56","author":"Erdem","year":"2008","journal-title":"Neurol. India"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1067\/mic.2002.119925","article-title":"Hospital-acquired meningitis in patients undergoing craniotomy: Incidence, evolution, and risk factors","volume":"30","author":"Reichert","year":"2002","journal-title":"Am. J. Infect. Control."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1237","DOI":"10.1227\/01.NEU.0000186038.98817.72","article-title":"Polymerase chain reaction for the rapid detection of cerebrospinal fluid shunt or ventriculostomy infections","volume":"57","author":"Banks","year":"2005","journal-title":"Neurosurgery"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1016\/j.cmi.2017.05.013","article-title":"Management of post-neurosurgical meningitis: Narrative review","volume":"23","author":"Hussein","year":"2017","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"acmi000100","DOI":"10.1099\/acmi.0.000100","article-title":"16S rRNA Gene PCR\/Sequencing of Cerebrospinal Fluid in the Diagnosis of Post-operative Meningitis","volume":"2","author":"Ramakrishna","year":"2020","journal-title":"Access Microbiol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1002\/acn3.51517","article-title":"Nanopore 16S sequencing enhances the detection of bacterial meningitis after neurosurgery","volume":"9","author":"Jang","year":"2022","journal-title":"Ann. Clin. Transl. Neurol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e2284","DOI":"10.6061\/clinics\/2021\/e2284","article-title":"Polymerase chain reaction targeting 16S ribosomal RNA for the diagnosis of bacterial meningitis after neurosurgery","volume":"76","author":"Medeiros","year":"2021","journal-title":"Clinics"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"734","DOI":"10.1128\/JCM.42.2.734-740.2004","article-title":"Prospective study of use of PCR amplification and sequencing of 16S ribosomal DNA from cerebrospinal fluid for diagnosis of bacterial meningitis in a clinical setting","volume":"42","author":"Schuurman","year":"2004","journal-title":"J. Clin. Microbiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"879","DOI":"10.1111\/j.1469-0691.2007.01756.x","article-title":"Comparison of broad-range bacterial PCR and culture of cerebrospinal fluid for diagnosis of community-acquired bacterial meningitis","volume":"13","author":"Dotevall","year":"2007","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"3331","DOI":"10.1128\/JCM.00008-10","article-title":"Broad-range 16S rRNA PCR with cerebrospinal fluid may be unreliable for management of postoperative aseptic meningitis","volume":"48","author":"Zarrouk","year":"2010","journal-title":"J. Clin. Microbiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1007\/s15010-014-0590-8","article-title":"Value of multiplex PCR using cerebrospinal fluid for the diagnosis of ventriculostomy-related meningitis in neurosurgery patients","volume":"42","author":"Rath","year":"2014","journal-title":"Infection"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1586","DOI":"10.3171\/2014.11.JNS141036","article-title":"Evaluation of a multiplex polymerase chain reaction for early diagnosis of ventriculostomy-related infections","volume":"123","author":"Gordon","year":"2015","journal-title":"J. Neurosurg."},{"key":"ref_24","first-page":"804","article-title":"Evaluation of Post-operative Meningitis: Comparison of Meningitis Caused by Acinetobacter spp. and Other Possible Causes","volume":"29","author":"Senturk","year":"2019","journal-title":"Turk. Neurosurg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"61","DOI":"10.4266\/acc.2021.01151","article-title":"Nosocomial meningitis in intensive care: A 10-year retrospective study and literature review","volume":"37","author":"Valdoleiros","year":"2022","journal-title":"Acute Crit. Care"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1016\/j.jhin.2011.08.021","article-title":"Nosocomial postneurosurgical Acinetobacter baumannii meningitis: A retrospective study of six cases admitted to Hamad General Hospital, Qatar","volume":"80","author":"Khan","year":"2012","journal-title":"J. Hosp. Infect."},{"key":"ref_27","first-page":"589","article-title":"The Causes of Postoperative Meningitis: The Comparison of Gram-Negative and Gram-Positive Pathogens","volume":"28","author":"Kurtaran","year":"2018","journal-title":"Turk. Neurosurg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1016\/S1413-8670(10)70090-8","article-title":"Mortality rate in patients with nosocomial Acinetobacter meningitis from a Brazilian hospital","volume":"14","author":"Tuon","year":"2010","journal-title":"Braz. J. Infect. Dis."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"755","DOI":"10.1007\/s10096-017-3171-9","article-title":"Coagulase-negative staphylococci are associated to the mild inflammatory pattern of healthcare-associated meningitis: A retrospective study","volume":"37","author":"Couffin","year":"2018","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"4907","DOI":"10.1128\/AAC.00345-09","article-title":"Penetration of colistin into cerebrospinal fluid","volume":"53","author":"Markantonis","year":"2009","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"ofw077","DOI":"10.1093\/ofid\/ofw077","article-title":"Clinical Characteristics and Predictors of Adverse Outcome in Adult and Pediatric Patients with Healthcare-Associated Ventriculitis and Meningitis","volume":"3","author":"Srihawan","year":"2016","journal-title":"Open Forum. Infect. Dis."}],"container-title":["Infectious Disease Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2036-7449\/14\/3\/45\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T23:24:20Z","timestamp":1760138660000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2036-7449\/14\/3\/45"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,6,3]]},"references-count":31,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2022,6]]}},"alternative-id":["idr14030045"],"URL":"https:\/\/doi.org\/10.3390\/idr14030045","relation":{},"ISSN":["2036-7449"],"issn-type":[{"value":"2036-7449","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,6,3]]}}}