Risk factors for mortality in patients with bacterial meningitis following a neurosurgical procedure: A meta‑analysis

The treatment of post‑operative bacterial meningitis (POBM) poses challenges due to multiple factors, including a broader spectrum of pathogens, compromised neurological status or comorbidities at baseline, and concurrent conditions that can lead to delayed diagnosis. Studies examining risk factors for mortality in patients with POBM remain insufficient. The present study conducted a meta‑analysis investigating various determinants considered to affect the mortality rates of patients with POBM. The key factors examined included age, comorbidity, cerebrospinal fluid (CSF) lactate levels, CSF glucose levels, initial Glasgow coma scale (GCS) score and the presence of Gram‑negative bacteria. Relevant literature was identified through searches on the PubMed, Science Direct, The Cochrane Library, and the Directory of Open Access Journals databases. The present meta‑analysis adhered to the guidelines outlined by the Preferred Reporting Items for Systematic Reviews and Meta‑Analyses (PRISMA), employing specific inclusion criteria. A total of 82 publications met the inclusion criteria. The mortality rate due to POBM was found to be 28% [with a 95% confidence interval (CI) of 23‑32%]. The presence of comorbidity had a mortality risk ratio of 1.97 (with a 95% CI of 1.58‑2.46). The mean difference for age was 4.65 years (with a 95% CI of 1.78‑7.52). The pooled mean for CSF lactate was 52.88 mg/dl (with a 95% CI of 38.14‑67.62). The mean difference for CSF glucose was ‑13.55 (with a 95% CI of ‑20.95 to ‑6.15). The mean difference for GCS was ‑1.69 (with a 95% CI of ‑2.51 to ‑0.86). There was no significant difference in the mortality risk between those with Gram‑negative bacteria and those with Gram‑positive bacteria. On the whole, these outcomes suggest that among survivors and non‑survivors of POBM, there are no significant differences in age or initial GCS scores. However, the presence of comorbidities increases the risk of mortality, and non‑survivors of POBM have lower CSF glucose levels.