Bacterial meningitis associated with lumbar drains: a retrospective cohort study

OBJECTIVES The infective potential of lumbar drainage is an important topic deserving particular study. The aetiology, incidence, and clinical findings associated with bacterial meningitis are described in patients having continuous lumbar CSF drainage to treat communicating hydrocephalus after suba...

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Bibliographic Details
Published in:Journal of neurology, neurosurgery and psychiatry neurosurgery and psychiatry, 1999-10, Vol.67 (4), p.468-473
Main Authors: Coplin, William M, Avellino, Anthony M, Kim, D K, Winn, H Richard, Grady, M Sean
Format: Article
Language:English
Subjects:
Adult
Aged
Antibiotics
Biological and medical sciences
Catheters
cerebrospinal fluid
Cerebrospinal fluid. Spinal cord. Spinal roots. Spinal nerves
Cohort analysis
Cohort Studies
Diagnostic tests
Glucose
Hemorrhage
Humans
Hydrocephalus
Infections
Iodine
lumbar drainage
Medical sciences
Meningitis
Meningitis, Bacterial - etiology
Middle Aged
Neurosurgery
Neutrophils
Patients
Proteins
Retrospective Studies
Risk Factors
Spinal Puncture - adverse effects
Subarachnoid Hemorrhage - cerebrospinal fluid
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
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Summary:OBJECTIVES The infective potential of lumbar drainage is an important topic deserving particular study. The aetiology, incidence, and clinical findings associated with bacterial meningitis are described in patients having continuous lumbar CSF drainage to treat communicating hydrocephalus after subarachnoid haemorrhage or CSF leaks after traumatic dural rents. METHODS Retrospective review of the records of patients with a positive CSF bacterial culture who underwent lumbar drain placement over a 39 month period. RESULTS Thirteen cases of bacterial meningitis occurred subsequent to the use of 312 lumbar drain kits (4.2%). All meningitic patients had CSF pleocytosis, but not all had peripheral leukocytosis. Fever, peripheral leukocytosis, and CSF pleocytosis did not help to differentiate the presence of bacterial meningitis from other infections. Eight patients had prior CSF drainage procedures, including ventriculostomy (n=5) or lumbar drain (n=5) placements; two patients received both procedures. Six of 13 patients developed their CSF infection within 24 hours of lumbar drain insertion. Six of 13 patients developed meningitis while receiving antibiotics for other reasons. CONCLUSIONS External lumbar drainage seems to carry a low risk of infectious meningitis and offers a safe alternative to ventriculostomy or serial lumbar punctures. Antibiotics do not seem to protect completely against developing the infection. The infection happens most often with skin organisms. The meningitis often appears within 24 hours after lumbar drain placement. Daily CSF samples should include bacterial cultures but cell counts may not offer any additional useful information in diagnosing the complication. Lumbar drain insertion and management need not be confined to the intensive care unit.
ISSN:0022-3050
1468-330X
DOI:10.1136/jnnp.67.4.468