Yu Xin, Liu Rui, Wang Yaming, Zhao Hulin, Chen Jinhui, Zhang Jianning, Hu Chenhao
Department of Neurosurgery, Navy General Hospital, Beijing, China.
Medicine (Baltimore). 2017 May;96(21):e6359. doi: 10.1097/MD.0000000000006359.
Despite advances in surgical techniques in the management of the brain abscess, continuous systemic long-term antibiotics are necessary and crucial. This study was designed to evaluate the effect of intracavity administration of high-dose antibiotics on the course of antibiotic therapy.
Between 2003 and 2013, 55 patients with bacterial brain abscesses (83 abscesses) were treated with stereotactic aspiration and intracavity injection of high-dose antibiotics combined with a short course systemic antibiotic therapy. Antibiotics of one-eighth daily systemic dosage were injected into the abscess cavity after stereotactic aspiration and intravenous antibiotics were given in all patients for 3 to 4 weeks. The results of the group treated with stereotactic aspiration and intracavity injection of antibiotic solution were compared to the results of our previous patients treated by stereotactic aspiration only.
Thirty-nine males and 16 females (age ranging from 1.5 to 76 years; mean age 38.7 years) were included in this study. During the follow-up (mean 26.2 months, ranging from 6 to 72 months), all the abscesses subsided with no recurrence. No adverse effects related to topical use of antibiotics occurred. At the end of follow-up, 38 patients had good outcomes, 11 had mild neurological deficits, 3 had moderate deficits, 1 was in vegetative state, and 2 died of accidents not related to brain abscesses. Compared with conventional stereotactic aspiration and drainage, intracavity injection of antibiotics shorted the course of consecutive systemic intravenous antibiotics by average 10.8 days without an increase of the recurrence rate of abscesses.
Our results indicate that topical application of antibiotics into the brain abscess cavity helps to reduce the length of systemic antibiotic therapy, decreases the abscess recurrence rate, avoids the side effects of long-term high dose antibiotics, shortens the hospitalization and reduces treatment costs.
尽管脑脓肿治疗的手术技术有所进步，但持续的全身性长期抗生素治疗仍是必要且关键的。本研究旨在评估高剂量抗生素腔内给药对抗生素治疗疗程的影响。
2003年至2013年期间，55例细菌性脑脓肿患者（83个脓肿）接受了立体定向抽吸和高剂量抗生素腔内注射联合短期全身性抗生素治疗。立体定向抽吸后，将每日全身用量八分之一的抗生素注入脓肿腔，所有患者静脉使用抗生素3至4周。将立体定向抽吸并注射抗生素溶液治疗组的结果与我们之前仅接受立体定向抽吸治疗的患者的结果进行比较。
本研究纳入39例男性和16例女性（年龄1.5至76岁；平均年龄38.7岁）。在随访期间（平均26.2个月，范围6至72个月），所有脓肿均消退且无复发。未出现与局部使用抗生素相关的不良反应。随访结束时，38例患者预后良好，11例有轻度神经功能缺损，3例有中度缺损，1例处于植物人状态，2例死于与脑脓肿无关的意外事故。与传统的立体定向抽吸和引流相比，抗生素腔内注射使连续全身性静脉抗生素治疗疗程平均缩短10.8天，且脓肿复发率未增加。
我们的结果表明，向脑脓肿腔内局部应用抗生素有助于缩短全身性抗生素治疗的疗程，降低脓肿复发率，避免长期高剂量抗生素的副作用，缩短住院时间并降低治疗成本。
