Risk factors for central nervous system infection after craniotomy for gliomas: a 8-year experience from a tertiary medical center

Abstract

Object: Due to the fact that glioma surgery requires manipulation of the brain parenchyma and the expression of inflammatory mediators, there is often a possibility of central nervous system (CNS) infection occurring after surgery. Previous studies on CNS infections related to neurosurgery have uniformly explored the risk factors for CNS infections in all neurosurgery surgeries that require craniotomy, but have not explored the risk factors and clinical characteristics of CNS infections after glioma resection. Methods: We included patients who underwent glioma resection from January 2015 to March 2023, systematically recorded population characteristics, clinical, surgical, laboratory and survival data, analyzed high-risk factors for postoperative CNS infections, summarized cerebrospinal fluid characteristics, antibiotic use, and explored whether CNS infections affects the long-term prognosis of glioma patients after surgery. Results:All 337 patients underwent glioma resection, and 61 patients (18.1%) developed CNS infections after surgery. Ventricle Opening, post-op other systemic infections, post-op maximum cavity diameter, and peripheral blood Monocyte% are independent risk factors for postoperative CNS infections. The median protein content in cerebrospinal fluid of patients with CNS infections is 1.73g/L ([IQR] 1.03-3.06), the median glucose content is 2.7mmol/L ([IQR] 1.90-3.70), and the median WBC is 1478×10⁶cells/L ([IQR] 467-4204.25×10⁶), with a median percentage of multinucleated cells of 84.1% ([IQR] 74.55% -90.83%). Meropenem and Vancomycin are the most commonly used antibiotics, with an average usage time of 7.79 days and 8.41 days, respectively. Survival analysis suggests that the occurrence of CNS infections does not affect the long-term prognosis of glioma patients after surgery. Conclusions: This study separately explored the risk factors for CNS infections in patients with glioma after surgery, instead of all diseases which need craniotomy，and summarized their cerebrospinal fluid characteristics and antibiotic use. Although CNS infection is only one of the possible complications during the treatment of gliomas, we believe that this will make a certain contribution to neurosurgeons' individualized prevention, diagnosis, and treatment of patients in the diagnosis and treatment of gliomas.