Health care-associated meningitis: Clinical epidemiology and predictor for 90-day mortality

Aims: To express the clinical predictor and epidemiology of patients with health care-associated meningitis (HAM) and launch a survival analysis to screen mortality predictors. Method A retrospective cohort analysis containing more than 70000 patients was evaluated. Clinical and microbial epidemiology, therapy and mortality of HAM patients were reviewed. Multivariable Cox proportional hazard models were applied to achieve survival analysis. Result 900 HAM patients from 3244 cases with cerebrospinal fluid(CSF) culture positivity were selected for epidemiology and survival analysis. The 90-day mortality was 12.4% (112 of 900) in people with HAM. Hypertension, external ventricular drainage (EVD), and lumbar drainage (LD) are mortality predictors for HAM, with a hazard ratio (HR) of 2.097 (95% C.I. 1.308–3.361, P = 0.002), 1.709 (95% C.I. 1.119–2.611, P = 0.013), and 1.614 (95% C.I. 1.083–2.405, P = 0.019). Reoperation was a factor favoring mortality, with an HR of 0.615 (95% C.I. 0.397–0.951, P = 0.029). In treatment, the outcome of patients receiving three or more antibiotic combinations is better than that of patients receiving dual-drug combinations. Conclusion The mortality of patients with HAM was relatively high, and the most important factors related to 90-days survival were hypertension, EVD and LD and treatment with three or more antibiotics are much better.