Original Research

Multidrug-resistant pathogens and outcomes in post-neurosurgical meningitis: A case control study

Faiza Ilyas
Aga Khan University Hospital, Karachi, Pakistan
Shariqa Batool
Aga Khan University Hospital, Karachi, Pakistan
Sher M. Sethi
Aga Khan University Hospital, Karachi, Pakistan
Saadia Sattar
Aga Khan University Hospital, Karachi, Pakistan
Iffat Khanum
Aga Khan University Hospital, Karachi, Pakistan
Nosheen Nasir
Aga Khan University Hospital, Karachi, Pakistan

✉ Correspondence: Nosheen Nasir Email: nosheen.nasir@aku.edu

DOI https://doi.org/10.70302/jpsim.v7i3.2646
Volume: 7, Issue 3 Pages: 244–251 Published: 21 Aug 2026
Received: 07 Apr 2026 Revised: 19 Jun 2026 Accepted: 12 Aug 2026 Published Online: 21 Aug 2026

Abstract

Objectives

Post-neurosurgical meningitis remains a significant challenge, particularly in low-resource settings with a high burden of antimicrobial resistance. This study compared risk factors, microbiological profiles, and clinical outcomes between culture-positive and culture-negative nosocomial meningitis.

Methods

We conducted a case-control study of adults who developed meningitis following neurosurgical procedures at a tertiary care hospital in Karachi, Pakistan (2013–2022). Patients were categorized into culture-positive (cases) and culture-negative (controls). Demographic, clinical, microbiological, and outcome data were collected. Multivariable logistic regression was used to identify factors independently associated with culture-positive meningitis.

Results

Among 85 patients, 46 (54%) were culture-positive. Excision of space-occupying lesions (SOL) was more frequent in culture-negative patients on univariate analysis; however, multivariable regression demonstrated that SOL excision was associated with lower odds of culture-positive meningitis (adjusted OR 0.33; 95% CI: 0.11–0.99; p = 0.05). Gram-negative organisms predominated (89%), with multidrug-resistant Acinetobacter baumannii being the most common isolate. Colistin (37.9%) and amikacin (28.3%) showed the highest antimicrobial susceptibility. Clinical outcomes were significantly worse among culture-positive patients, including higher mortality (28.3% vs. 10.3%; p = 0.05) and a longer hospital stay (median: 23 vs. 11 days; p < 0.001).

Conclusion

Culture-positive post-neurosurgical meningitis is predominantly caused by multidrug-resistant gram-negative organisms and is associated with significantly higher mortality and prolonged hospitalization. Improved diagnostic strategies and antimicrobial stewardship are critical in resource-limited neurosurgical settings.

Keywords
nosocomial meningitis neurosurgical infections cerebrospinal fluid antimicrobial resistance Acinetobacter baumannii

How to Cite This Article

Ilyas F, Batool S, Sethi SM, Sattar S, Khanum I, Nasir N. Multidrug-resistant pathogens and outcomes in post-neurosurgical meningitis: A case control study. J Pak Soc Intern Med. 2026;7(3):244–251. doi:10.70302/jpsim.v7i3.2646

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Conflict of Interest

The authors declare no conflict of interest.

Disclosed in accordance with ICMJE and COPE guidelines.

Funding

This research received no specific grant from any funding agency.

Funder information follows the Crossref Funder Registry standard.

Ethics Statement

not_applicable

Conducted in accordance with the Declaration of Helsinki.

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CC BY CC BY 4.0 This article is published under the Creative Commons Attribution 4.0 International License. May be shared and adapted with attribution. © 2026 Journal of Pakistan Society of Internal Medicine.
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