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Vol. 20. Issue 2.
Pages 103-108 (January 2009)
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Vol. 20. Issue 2.
Pages 103-108 (January 2009)
Meningitis postquirúrgica. Características diferenciales de la meningitis aséptica post-quirúrgica
Postsurgical meningitis. Differential characteristics of aseptic postsurgical meningitis
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6393
A. Ramos-Martínez
, T. de las Heras-Carballo, T. Álvarez de Espejo-Montiel, N. Escamilla-Fernández
Servicios de Medicina Interna (Unidad de Infecciosas). Hospital Universitario Puerta de Hierro. Madrid
Fernández-Mateos*, L. de Reina*
* Servicios de Medicina Interna (Unidad de Infecciosas) Neurocirugía. Hospital Universitario Puerta de Hierro. Madrid
I. Sánchez-Romero**
** Servicios de Medicina Interna (Unidad de Infecciosas) Microbiología. Hospital Universitario Puerta de Hierro. Madrid
I. Millán***
*** Servicios de Sección de Bioestadística. Hospital Universitario Puerta de Hierro. Madrid
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Resumen
Introducción

La meningitis postquirúrgica es una complicación infrecuente que se acompaña de un incremento de la estancia hospitalaria y de una elevada mortalidad. Algunos de estos casos no son debidos a una verdadera infección sino a una inflamación aséptica de las meninges denominada meningitis aséptica post-quirúrgica (MAPQ). La adecuada identificación de estos casos permitiría una mejor utilización de los fármacos antimicrobianos.

Material y métodos

Estudio retrospectivo de los pacientes con meningitis postquirúrgica en un hospital terciario durante 14 años comparando las características clínicas de los pacientes con meningitis bacteriana postquirúrgica (MBP) frente a las de pacientes con MAPQ

Resultados

Durante el período analizado se identificaron 35 pacientes (71%) con MBP y 14 pacientes (29%) con MAPQ. La edad media de los pacientes con MBP fue similar a la de los pacientes con MAPQ. Hubo predominio de varones en el grupo de MBP (71%) en relación con los pacientes con MAPQ (36%, p=0,020). La proporción de pacientes con hemorragia intracraneal tendió a ser más frecuente en pacientes que posteriormente desarrollaron MAPQ (9 pacientes, 64%) que en los pacientes con MBP (12 casos, 34%, p=0,055). Los pacientes sometidos a craneotomía posterior (p=0,092) y los que recibían tratamiento esteroideo (p=0,051) mostraron una mayor tendencia a padecer MAPQ. Siete pacientes MBP (20%) presentaron un recuento celular superior a 5000células/mm3 en el LCR, cifra no encontrada en ningún caso de MAPQ. No se detectaron diferencias en la glucorraquia y proteinorraquia entre ambos grupos. La bacterias más frecuentemente aisladas fueron Staphylococcus coagulasa negativa y S. aureus. En 5 pacientes (14%) se aislaron bacilos gramnegativos no fermentadores (Pseudomonas aeruginosa y Acinetobacter spp). No hubo ningún fallecimiento atribuido a meningitis postquirúrgica.

Conclusión

Los pacientes sometidos a neurocirugía que fueron ingresados por hemorragia cerebral, intervenidos de la fosa posterior o tratados con esteroides presentan una mayor tendencia a presentar MAPQ. Los recuentos celulares en LCR elevados (superiores a 5000 células/mm3) sugieren la existencia de MBP.

Palabras clave:
Neurocirugía
Meningitis aséptica
Hemorragia intracraneal
Staphylococcus
Abreviaturas:
LCR
MAPQ
MP
MBP
Summary
Background

Postsurgical meningitis is a rare complication that is accompanied by an increase of hospital stay and high mortality. Some of these cases are not due to a true infection but due to an aseptic inflammation of the meninges denominated aseptic postsurgical meningitis (APSM). Proper identification of these cases would allow better use of antimicrobial drugs.

Methods

A retrospective study of patients with postsurgical meningitis in a universitary hospital for 14 years. We describe the clinical characteristics of patients with postsurgical bacterial meningitis (PBM) compared to those of patients with APSM.

Results

During the studied period 35 patients (71%) with PBM and 14 patients (29%) with (APSM) were identified. The mean age of patients with PBM was similar to that of patients with APSM. There was a male predominance in the group of PBM (71%) compared with patients with APSM (36%, p=0.020). Patients with intracranial hemorrhage tended to present more cases of APSM (64%) than of PBM (34%, p=0.055). Patients undergoing posterior fossa craniotomy (p=0.092) and those receiving steroids (p=0.051) showed a greater tendency to suffer APSM. It was also noted a trend towards present PBM in patients who had suffered an infection in the previous month (p=0.072). There were seven patients with PBM (20%) with a cell count above 5000 cells/mm3 in CSF, values not found in any patients with APSM. No differences were detected in the glycorrachia and proteinorrachia between the two groups. The most common bacteria isolated were coagulase negative Staphylococcus and S. aureus. In 5 patients (14%) non fermenting gram-negative bacillus (Pseudomonas aeruginosa and Acinetobacter spp) were isolated. There were no deaths attributed to any type of postsurgical meningitis.

Conclusion

Patients admitted for brain haemorrhage, undergoing posterior fossa surgery or receiving steroids tend to develop APSM. A CSF cell count above 5000 cells/mm3 strongly suggests MBP.

Key words:
Neurosurgery
Meningitis aseptic
Intracranial hemorrhages
Staphylococcus

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