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Neurology India, Vol. 59, No. 2, March-April, 2011, pp. 154-155 Editorial Post-craniotomy meningitis Sanjay Behari Deparment of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India Correspondence Address: Sanjay Behari, Deparment of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India, sbehari27@yahoo.com Date of Submission: 16-Nov-2010 Code Number: ni11048 PMID: 21483107 DOI: 10.4103/0028-3886.79122 The authors of the paper on incidence of postoperative meningitis in this issue of the journal [1] need to be commended on their focused response towards a large number of patients over 7 years in keeping the infection rates low in an extremely busy public hospital. This study exemplifies the fact that a proper record keeping, paying attention to small details, translating the conclusions obtained following analysis of basic investigational and research data into actual clinical practice and adhering to proper protocols goes a long way in bringing about a paradigm shift in the quality of patient care. This study also highlights the fact that a proper system of evaluating culture and sensitivity patterns of infective organisms and their constant review as well as a departmental antibiotic policy prevents the abuse of these life-saving drugs and prevents multi-drug resistant organisms from developing. This, finally, translates into a huge economic benefit both for the hospital and the patients. An important fact that emerges from this study is that the pattern of infective organisms greatly varies across countries and individual institutions and is unique to every single hospital. It is, therefore, imperative for health care providers to maintain meticulous records of their own patients and hospitals and not rely absolutely on the data provided by other institutions which may be vastly different from their own. The conclusions of this study, however, should be interpreted keeping in mind some reservations. The authors have included only those postoperative neurosurgical patients with meningitis with bacteriological positivity in cerebrospinal fluid cultures. The extremely low infection rate observed in the present study, therefore, is not a true representation of the actual infection rate prevalent amongst postoperative neurosurgical patients in the hospital since the following subgroups of patients were excluded from the study: those with anaerobic and fungal infections; those who had postoperative meningitis and did not have positive cerebrospinal fluid cultures; and, those with postoperative meningitis in whom a lumbar puncture was contraindicated due to raised intracranial pressure. There would also be a large number of patients who developed bacterial infection but not actual meningitis who would also not form a part of this study. These subgroups do constitute a substantial number of patients in any hospital. Apart from prophylactic antibiotics, proper air conditioning filters, laminar flow in the operating room, proper sterilization procedures, adequately trained personnel, complexity, duration and emergent/elective nature of the procedure as well as the immune status and coexisting medical disease of the patient all contribute towards the incidence of infection. Although inclusion of all these factors goes much beyond the scope of this paper, they should also be kept in mind while making attempts to focus on lowering hospital infection rates. Finally, I would like to acknowledge in reference to my comments, the commendable efforts made by other Indian authors in sharing their experience in the form of systematic long-term studies in this field. [2],[3] Their efforts, as will this study, go a long way in inspiring others to take the cudgels in this vital area and establish the much needed "protocols and reforms for infection control in neurosurgical patients" for the entire country. References
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