Nosocomial meningitis prophylaxis in adult craniocerebral neurosurgery (literature review)
https://doi.org/10.24884/2078-5658-2026-23-2-102-110
Abstract
Introduction. Nosocomial meningitis (NM) is a rare but difficult-to-diagnose and treat complication of neurosurgical procedures.
Materials and methods. A literature search and analysis was performed in the medical information systems PubMed and eLibrary, using the following keywords: nosocomial meningitis, postneurosurgical meningitis, surgical site infection (SSI), device-associated infection.
Results. The main strategy for counteracting NM in neurosurgery represents an integrated approach to its prevention at all stages of the perioperative period. This approach includes strict adherence to aseptic rules, optimization of work with tissues and compliance with an adequate regimen of antibiotic prophylaxis; its implementation can reduce the risk of developing NM. Prolonged administration of antibacterial drugs in the postoperative period and their local administration into the surgical wound remain a subject of debate.
Conclusion. An emphasis on perioperative preventive measures can reduce the incidence of NM and improve outcomes following neurosurgery.
About the Authors
A. M. Nikonov
Northern State Medical University;
First City Clinical Hospital named after E. E. Volosevich
Russian Federation
Russian Federation
Nikonov Anton M., Postgraduate Student of the Department of Anesthesiology and Intensive Care, Northern State Medical University
Arkhangelsk
A. R. Avidzba
Northern State Medical University;
First City Clinical Hospital named after E. E. Volosevich
Russian Federation
Russian Federation
Avidzba Alexey R., Cand. of Sci. (Med.), Anesthesiologist and Intensivist, First City Clinical Hospital named after E. E. Volosevich
Arkhangelsk
V. A. Saskin
Northern State Medical University;
First City Clinical Hospital named after E. E. Volosevich
Russian Federation
Russian Federation
Saskin Vitalii A., Cand. of Sci. (Med.), Associate Professor of the Department of Anesthesiology and Intensive Care, Northern State Medical University
Arkhangelsk
M. Yu. Kirov
Northern State Medical University;
First City Clinical Hospital named after E. E. Volosevich
Russian Federation
Russian Federation
Kirov Mikhail Y., Dr. of Sci. (Med.), Professor, Corresponding Member of the RAS, Head of the Department of Anesthesiology and Intensive Care, Northern State Medical University
Arkhangelsk
References
1. Ajbazova M. I., Dryagina N. V., Tsentsiper L. M. et al. Nosocomial meningitis and ventriculitis: clinic, diagnosis, prevention (literature review). Messenger of Anesthesiology and Resuscitation, 2025, vol. 22, no. 3, pp. 108–118. (In Russ.). https://doi.org/10.24884/2078-5658-2025-22-3-108-118.
2. Bodareva N. V., Savvina I. A., Sidorin V. S., Zabrodskaya Yu. M. Sepsis in Neurosurgical Patients (Based on Autopsy Data from the Professor A. L. Polenov Research Neurosurgical Institute). Rossiiskii neirokhirurgicheskii zhurnal imeni professora A. L. Polenova, 2017, vol. 9, no. S, pp. 33–34. (In Russ.).
3. Briko N. I., Bozhkova S. A., Brusina E. B. et al. Prevention of Surgical Site Infections: Clinical Guidelines / Ministry of Health of the Russian Federation; National Association of Specialists in Healthcare-Associated Infection Control. Nizhny Novgorod, Remedium Privolzhye, 2018, 72 p. (In Russ.).
4. Kurdyumova N. V., Danilov G. V., Ershova O. N. et al. Features of the course of nosocomial meningitis in patients of neurosurgical intensive care unit. Zhurnal voprosy neĭrokhirurgii imeni N. N. Burdenko, 2015, vol. 79, no. 3, pp. 55–59. (In Russ.). http://doi.org/10.17116/neiro201579355-59.
5. Kurdyumova N. V., Ershova O. N., Savin I. A. et al. Drainage-associated meningitis in neurocritical care patients. The results of a five-year prospective study. Zhurnal voprosy neĭrokhirurgii imeni N. N. Burdenko, 2017, vol. 81, no. 6, pp. 56–63. (In Russ.). http://doi.org/10.17116/neiro201781656-62.
6. Kurdyumova N. V., Savin I. A., Ershova O. N. et al. Nosocomial Meningitis Caused by Acinetobacter baumannii in ICU Patients. Anesteziologiya i reanimatologiya, 2019, no. 4, pp. 43–49. (In Russ.). http://doi.org/10.17116/anaesthesiology201904143.
7. Kurdyumova N. V., Savin I. A., Ershova O. N. et al. Nosocomial Meningitis in Neurosurgery. Anesteziologiya i reanimatologiya, 2021, no. 6, pp. 82–90. (In Russ.). http://doi.org/10.17116/anaesthesiology202106182.
8. Kurdyumova N. V., Savin I. A., Ershova O. N. et al. Risk Factors of Nosocomial Meningitis in Neurological Intensive Care Unit. Results of a Five-Year Prospective Study. Zhurnal voprosy neirokhirurgii imeni N. N. Burdenko, 2021, vol. 85, no. 6, pp. 83–91. (In Russ.). http://doi.org/10.17116/neiro20218506183.
9. Kurdyumova N. V., Usachev D. Yu., Savin I. A. et al. Nosocomial Meningitis Laboratory Criteria in ICU Patients: 5-Year Surveillance. Vestnik anesteziologii i reanimatologii, 2021, vol. 18, no. 5, pp. 47–56. (In Russ.). http://doi.org/10.21292/2078-5658-2021-18-5-47-56.
10. Lavrinenko N. V., Savvina I. A., Khanina I. M. Assessment of the Risk of Purulent-Septic Complications in Patients with Severe Traumatic Brain Injury. Rossiiskii neirokhirurgicheskii zhurnal imeni professora A. L. Polenova, 2018, vol. 10, no. S, pp. 145–146. (In Russ.).
11. Morozov A. M., Zhukov S. V., Belyak M. A., Stamenkovich A. B. Assessment of Economic Losses Due to the Development of Surgical Site Infection. Menedzher zdravookhraneniya, 2022, no. 1, pp. 54–60. (In Russ.). http://doi.org/10.21045/1811-0185-2022-1-54-60.
12. Morozov A. M., Sergeev A. N., Chervinets V. M. et al. Methods of Preventing Surgical Site Infections. Ambulatornaya khirurgiya, 2024, vol. 21, no. 1, pp. 168–176. (In Russ.). http://doi.org/10.21518/akh2024-013.
13. SСAT Program (Strategy for Control of Antimicrobial Therapy) in Inpatient Medical Care: Russian Practical Recommendations / ed. by S. V. Yakovlev, S. V. Sidorenko, D. Yu. Protsenko, N. I. Briko. 3rd edition, revised and expanded. Moscow, Publishing House “MedKom-Pro”, 2025, 345 p. (In Russ.).
14. Stepanov I. A., Beloborodov V. A., Borisov V. E. et al. The Effectiveness of Local Application of Vancomycin Powder in the Prevention of Surgical Site Infections in Spine Surgery: A Meta-Analysis. Khirurgiya. Zhurnal im. N. I. Pirogova, 2020, no. 6, pp. 60–70. (In Russ.). http://doi.org/10.17116/hirurgia202006160.
15. Epidemiological Diagnosis of Healthcare-Associated Infections Based on Standard Case Definitions: Methodological Recommendations [Electronic Resource] / Association “National Association of Specialists in Control of Infectious and Non-Infectious Diseases” (NASCI), 2024. URL: https://nasci.confreg.org/libs/files/mr_sos.pdf (accessed: 26.12.2025). (In Russ.).
16. Allegranzi B., Bischoff P., de Jonge S. et al. New WHO recommendations on preoperative measures for surgical site infection prevention: an evidence-based global perspective. The Lancet Infectious Diseases, 2016, vol. 16, no. 12, e276–e287. http://doi.org/10.1016/S1473-3099(16)30398-X.
17. Allegranzi B., Zayed B., Bischoff P. et al. New WHO recommendations on intraoperative and postoperative measures for surgical site infection prevention: an evidence-based global perspective. The Lancet Infectious Diseases, 2016, vol. 16, no. 12, e288–e303. http://doi.org/10.1016/S1473-3099(16)30402-9.
18. Berríos-Torres S. I., Umscheid C. A., Bratzler D. W. et al. Healthcare Infection Control Practices Advisory Committee. Centers for disease control and prevention guideline for the prevention of surgical site infection, 2017. JAMA, Surgery, 2017, vol. 152, no. 8, pp. 784–791. http://doi.org/10.1001/jamasurg.2017.0904.
19. Calderwood M. S., Anderson D. J., Bratzler D. W. et al. Strategies to prevent surgical site infections in acute-care hospitals: 2022 Update. Infection Control and Hospital Epidemiology, 2023, vol. 44, no. 5, pp. 695–720. http://doi.org/10.1017/ice.2023.67.
20. Ching P.R. Care bundles in surgical site infection prevention: a narrative review. Current Infectious Disease Reports, 2024, vol. 26, pp. 163–172. http://doi.org/10.1007/s11908-024-00837-9.
21. Daher M., Nassar J. E., McDonald C. L. et al. Does the application of topical vancomycin reduce surgical site infections in spine surgery? A meta-analysis of randomized controlled trials. Clinical Orthopaedics and Related Research, 2024, vol. 482, no. 12, pp. 2212–2219. http://doi.org/10.1097/CORR.0000000000003179.
22. Deora H., Nagesh M., Garg K. et al. Topical vancomycin for prevention of surgical site infection in cranial surgeries: results of an updated systematic review, meta-analysis and meta-regression. Neurology India, 2023, vol. 71, no. 5, pp. 875–883. http://doi.org/10.4103/0028-3886.388107.
23. Duquette E., Bhatti P., Sur S. et al. History and use of antibiotic irrigation for preventing surgical site infection in neurosurgery: a scoping review. World Neurosurgery, 2022, vol. 160, pp. 76–83. http://doi.org/10.1016/j.wneu.2022.01.098.
24. Gande A., Rosinski A., Cunningham T. et al. Selection pressures of vancomycin powder use in spine surgery: a meta-analysis. The Spine Journal, 2019, vol. 19, no. 6, pp. 1076–1084. http://doi.org/10.1016/j.spinee.2019.01.002.
25. Global guidelines for the prevention of surgical site infection. 2nd ed. Geneva: World Health Organization; 2018. 186 p.
26. Hong B., Apedjinou A., Heissler H. E. et al. Effect of a bundle approach on external ventricular drain-related infection. Acta Neurochirurgica, 2021, vol. 163, no. 4, pp. 1135–1142. http://doi.org/10.1007/s00701-020-04698-8
27. Horan T. C., Andrus M., Dudeck M. A. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. American Journal of Infection Control, 2008, vol. 36, no. 5, pp. 309–332. http://doi.org/10.1016/j.ajic.2008.03.002.
28. Hussein K., Bitterman R., Shofty B. et al. Management of post-neurosurgical meningitis: narrative review. Clinical Microbiology and Infection, 2017, vol. 23, no. 9, pp. 621–628. http://doi.org/10.1016/j.cmi.2017.05.013.
29. Kourbeti I. S., Vakis A. F., Ziakas P. et al. Infections in patients undergoing craniotomy: risk factors associated with post-craniotomy meningitis. Journal of Neurosurgery, 2015, vol. 122, no. 5, pp. 1113–1119. http://doi.org/10.3171/2014.8.JNS132557.
30. Li Y., Gao L., Fan S. The characteristics of surgical site infection with class I incision in neurosurgery. BMC Surgery, 2025, vol. 25, no. 1, pp. 97. http://doi.org/10.1186/s12893-025-02825-9.
31. Ling M. L., Apisarnthanarak A., Abbas A. et al. APSIC guidelines for the prevention of surgical site infections. Antimicrobial Resistance and Infection Control, 2019, vol. 8, pp. 174. http://doi.org/10.1186/s13756-019-0638-8.
32. Mann M., Wright C. H., Jella T. et al. Cranial surgical site infection interventions and prevention bundles: a systematic review of the literature. World Neurosurgery, 2021, vol. 148, pp. 206–219. e4. http://doi.org/10.1016/j.wneu.2020.12.137.
33. Martin R. M., Zimmermann L. L., Huynh M. et al. Diagnostic approach to health care- and device-associated central nervous system infections. Journal of Clinical Microbiology, 2018, vol. 56, no. 11, e00861–18. http://doi.org/10.1128/JCM.00861-18.
34. Okamura Y., Maruyama K., Fukuda S. et al. Detailed standardized protocol to prevent cerebrospinal fluid shunt infection. Journal of Neurosurgery, 2019, vol. 132, no. 3, pp. 755-759. http://doi.org/10.3171/2018.10.JNS181432.
35. Piednoir E., Robert-Yap J., Baillet P. et al. The socioeconomic impact of surgical site infections. Frontiers in public health, 2021, vol. 9, pp. 712461. http://doi.org/10.3389/fpubh.2021.712461.
36. Rojas-Lora M., Corral L., Zabaleta-Carvajal I. et al. External ventriculostomy-associated infection reduction after updating a care bundle. Annals of Clinical Microbiology and Antimicrobials, 2023, vol. 22, no. 1, pp. 59. http://doi.org/10.1186/s12941-023-00612-z.
37. Rubeli S. L., D’Alonzo D., Mueller B. et al. Implementation of an infection prevention bundle is associated with reduced surgical site infections in cranial neurosurgery. Neurosurgical Focus, 2019, vol. 47, no. 2, E3. http://doi.org/10.3171/2019.5.FOCUS19272.
38. Sartelli M., Coccolini F., Labricciosa F. M. et al. Surgical antibiotic prophylaxis: a proposal for a global evidence-based bundle. Antibiotics, 2024, vol. 13, no. 1, pp. 100. http://doi.org/10.3390/antibiotics13010100.
39. Seidelman J. L., Mantyh C. R., Anderson D. J. Surgical site infection prevention: a review. JAMA, 2023, vol. 329, no. 3, pp. 244–252. http://doi.org/10.1001/jama.2022.24075.
40. Strojnik T., Golc J., Zakelsek J. Infections of external ventricular drainages. Central European Journal of Medicine, 2013, vol. 8, pp. 250–256. http://doi.org/10.2478/s11536-012-0115-8.
41. Strengthening emergency and essential surgical care and anaesthesia as a component of universal health coverage / World Health Organization (WHO), 2015. URL: https://apps.who.int/gb/ebwha/pdf_files/WHA68/A68_R15-en.pdf?ua=1 (accessed: 26.12.2025).
42. Surveillance Definitions for Specific Types of Infections in the National Healthcare Safety Network (NHSN) / Centers for Disease Control and Prevention (CDC), 2025. URL: https://www.cdc.gov/nhsn/pdfs/pscmanual/9pscssicurrent.pdf (accessed: 26.12.2025).
43. Surveillance of surgical site infections in European hospitals – HAISSI protocol. Version 1.02. Stockholm: European Centre for Disease Prevention and Control, 2012, 47 p.
44. Tunkel A. R., Hasbun R., Bhimraj A. et al. 2017 Infectious Diseases Society of America’s Clinical Practice Guidelines for Healthcare-Associated Ventriculitis and Meningitis. Clinical Infectious Diseases, 2017, vol. 64, no. 6, e34–e65. http://doi.org/10.1093/cid/ciw861.
45. Tuon F. F., Penteado-Filho S. R., Amarante D. et al. Mortality rate in patients with nosocomial Acinetobacter meningitis from a Brazilian hospital. The Brazilian Journal of Infectious Diseases, 2010, vol. 14, no. 5, pp. 437–440.
46. Valdoleiros S. R., Torrão C., Freitas L. S. et al. Nosocomial meningitis in intensive care: a 10-year retrospective study and literature review. Acute and Critical Care, 2022, vol. 37, no. 1, pp. 61–70. http://doi.org/10.4266/acc.2021.01151.
47. Jiménez-Martínez E., Cuervo G., Carratalà J. et al. A Care Bundle Intervention to Prevent Surgical Site Infections After a Craniotomy. Clinical Infectious Diseases, 2021, vol. 73, no. 11, pp. e3921–e3928. http://doi.org/10.1093/cid/ciaa884.
48. Leverstein-van Hall M. A., Hopmans T. E., van der Sprenkel J. W. et al. A bundle approach to reduce the incidence of external ventricular and lumbar drain-related infections. Journal of Neurosurgery, 2010, vol. 112, no. 2, pp. 345–353. http://doi.org/10.3171/2009.6.JNS09223.
49. Savin I., Ershova K., Kurdyumova N. et al. Healthcare-associated ventriculitis and meningitis in a neuro-ICU: Incidence and risk factors selected by machine learning approach. Journal of Critical Care, 2018, vol. 45, pp. 95–104.
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For citations:
Nikonov A.M., Avidzba A.R., Saskin V.A., Kirov M.Yu. Nosocomial meningitis prophylaxis in adult craniocerebral neurosurgery (literature review). Messenger of ANESTHESIOLOGY AND RESUSCITATION. 2026;23(2):102-110. (In Russ.) https://doi.org/10.24884/2078-5658-2026-23-2-102-110
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