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Subject Area

Endemic and Tropical Medicine

Article Type

Original Study

Abstract

Objective This study aimed to the frequency, presentation, and outcome of meningitis after spinal anesthesia for various surgical procedures. Background Postoperative bacterial meningitis may result in prolonged hospitalization, an extended course of antibiotics, and possibly mortality. Patients and methods This cross-sectional study included 141 patients referred to El Mahala El Kobra Fever Hospital complaining of symptoms and signs of meningeal irritation after spinal anesthesia for different surgical procedures. The patients were classified according to the clinical, laboratory, and cerebrospinal fluid (CSF) analysis and culture into two groups: group I: positive for meningitis that included 79 patients, and group II: negative for meningitis that included 62 patients. Results Bad sterilization was statistically more common in meningitis group (P = 0.04), positive Kernig's sign, Brudzinski neck sign, and Brudzinski leg sign were significantly more frequent in group I (P = 0.026, 0.008, and 0.048, respectively). Mean Glasgow Coma Scale (GCS) was statistically significantly lower in meningitis group (P = 0.002). Total leukocyte count and C-reactive protein were significantly higher in GI. Complications during anesthesia, such as improper sterilization, worsening conscious level, GCS, serum creatinine level, and platelets were significant predictors of meningitis. About 44% of patients had no growth in CSF culture, 21.3% had Staphylococcus aureus, 14.2% had group-B Streptococci, 12% had Neisseria meningitidis, and 8.5% had Pseudomonas spp. Further analysis showed that history of chronic disease, neurological deficit, and low GCS, high total leukocyte count and C-reactive protein, positive blood culture, lower glucose, higher protein levels in CSF, and positive CSF culture were associated with poor outcome. Conclusion Postoperative meningitis, especially by S. aureus, is considered a serious complication following spinal anesthesia. A high level of suspicion and early management guard against lethal complications. Fever, headache, neck stiffness, and signs of meningeal irritation may be conflicting presentations, albeit should be considered and investigated for possibility of meningitis.

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