Multidrug-Resistant Pathogens and Outcomes in Post-Neurosurgical Meningitis: A Case Control Study

Authors

Abstract

Objective: 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.

Published

2026/08/21

Issue

Vol. Volume 7-issue 3

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