Head or Spine Surgery Increased Risk for Streptococcus pneumoniae Meningitis

Results from a case control study, published in Clinical Infectious Diseases, found prior head or spine surgery was associated with increased risk for Streptococcus pneumoniae meningitis outside of the postoperative period.

The study was conducted at various Kaiser Permanente healthcare consortium centers in northern California between January 1, 2008, and October 31, 2017. Patients age ≥18 years with an International Classification of Diseases 9 or 10 diagnosis code of bacterial or pneumococcal meningitis were identified and 84 individuals met inclusion criteria with positive cerebrospinal (CSF) culture for S pneumoniae, or CSF WBC count >10 leukocytes/μL and a positive blood culture or polymerase chain reaction for S pneumoniae within the same hospitalization. The 168 healthy control patients were matched 2:1 to cases by age, sex, medical facility, and Kaiser Permanente membership length. A blinded medical record review then identified individuals with prior head injury and head or spine surgeries.

Prior head injuries or head or spine surgeries had occurred in 17.9% of the cases and 3.6% of controls. Compared with controls, the case patients had a 6.5 times higher odds (95% CI, 1.94-12.89) of having head injury or head or spine surgeries. These odds remained significant when separated for head or spine surgeries only (odds ratio [OR] 6.0; 95% CI, 1.94-18.60) and not head injury (OR 3.0; 95% CI, 0.50-17.95). Among case patients only 33.3% had received any prior pneumococcal vaccinations.

According to the study investigators, this was the first study that demonstrated an association between prior head or spine surgeries and pneumococcal meningitis outside the 30-day postoperative period. While they acknowledged that additional studies are needed to verify the results of this relatively small study, researchers believe the data, “emphasize the need for provider education to improve overall adult pneumococcal vaccination rates.” Further, they concluded that prior head or spine surgeries should be considered a potential risk factor for pneumococcal meningitis in adults.

Researchers noted that future work should explore the risks involved with skull and facial fractures as well as the risk for other neuroinfectious diseases. Researchers also recommended vaccinating patients with prior or upcoming elective prior head or spine surgeries, especially those already in a risk group recommended for vaccination.

Reference

Chu V, Carpenter DM, Winter K, Harriman K, Glaser C. Increased risk of late-onset Streptococcus pneumoniae meningitis in adults with prior head or spine surgeries [published online November 19 2018]. Clin Infect Dis. doi: 10.1093/cid/ciy974