1Department of Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009 People's Republic of China.
Department of Critical Care Medicine, Anji County People's Hospital, Huzhou, Zhejiang Province 313300 China.
Antimicrob Resist Infect Control. 2018 Jan 19;7:8. doi: 10.1186/s13756-018-0305-5. eCollection 2018.
Post-neurosurgical intracranial infections caused by multidrug-resistant or extensively drug-resistant are difficult to treat and associated with high mortality. In this study, we analyzed the therapeutic efficacy of intravenous combined with intrathecal/intracerebral ventricle injection of polymyxin B for this type of intracranial infection.
This retrospective study was conducted from January 2013 to September 2017 at the Second Affiliated Hospital, Zhejiang University School of Medicine (Hangzhou,China) and included 61 cases for which cerebrospinal fluid (CSF) cultures were positive for multidrug-resistant or extensively drug-resistant after a neurosurgical operation. Patients treated with intravenous and intrathecal/intracerebral ventricle injection of polymyxin B were assigned to the intrathecal/intracerebral group, and patients treated with other antibiotics without intrathecal/intracerebral injection were assigned to the intravenous group. Data for general information, treatment history, and the results of routine tests and biochemistry indicators in CSF, clinical efficiency, microbiological clearance rate, and the 28-day mortality were collected and analyzed.
The rate of multidrug-resistant or extensively drug-resistant infection among patients who experienced an intracranial infection after a neurosurgical operation was 33.64% in our hospital. The isolated were resistant to various antibiotics, and most seriously to carbapenems (100.00% resistance rate to imipenem and meropenem), cephalosporins (resistance rates of 98.38% to cefazolin, 100.00% to ceftazidime, 100.00% to cefatriaxone, and 98.39% to cefepime). However, the isolated were completely sensitive to polymyxin B (sensitivity rate of 100.00%), followed by tigecycline (60.66%) and amikacin (49.18%). No significant differences in basic clinical data were observed between the two groups. Compared with the intravenous group, the intrathecal/intracerebral group had a significantly lower 28-day mortality (55.26% vs. 8.70%, = 0.01) and higher rates of clinical efficacy and microbiological clearance (95.65% vs. 23.68%, < 0.001; 91.30% vs. 18.42%, < 0.001, respectively).
Intravenous plus intrathecal/intracerebral ventricle injection of polymyxin B is an effective regimen for treating intracranial infections caused by multidrug-resistant or extensively drug-resistant
神经外科手术后由耐多药或广泛耐药引起的颅内感染难以治疗，死亡率高。在这项研究中，我们分析了静脉联合鞘内/脑室内注射多粘菌素 B 治疗此类颅内感染的疗效。
本回顾性研究于 2013 年 1 月至 2017 年 9 月在浙江大学医学院第二附属医院（杭州）进行，共纳入 61 例神经外科手术后脑脊液（CSF）培养阳性的耐多药或广泛耐药。患者接受静脉和鞘内/脑室内注射多粘菌素 B 治疗被分配到鞘内/脑室内组，接受其他抗生素治疗而无鞘内/脑室内注射的患者被分配到静脉组。收集并分析一般信息、治疗史以及 CSF 常规检查和生化指标的结果、临床疗效、微生物清除率和 28 天死亡率。
我院神经外科术后颅内感染患者中耐多药或广泛耐药的发生率为 33.64%。分离的细菌对各种抗生素均有耐药性，对碳青霉烯类（亚胺培南和美罗培南的耐药率均为 100.00%）、头孢菌素类（头孢唑啉的耐药率为 98.38%，头孢他啶、头孢曲松和头孢吡肟的耐药率均为 100.00%）耐药最为严重。然而，分离的细菌对多粘菌素 B 完全敏感（敏感性率为 100.00%），其次是替加环素（60.66%）和阿米卡星（49.18%）。两组的基本临床数据无显著差异。与静脉组相比，鞘内/脑室内组 28 天死亡率显著降低（55.26%比 8.70%，=0.01），临床疗效和微生物清除率更高（95.65%比 23.68%，<0.001；91.30%比 18.42%，<0.001）。
静脉联合鞘内/脑室内注射多粘菌素 B 是治疗耐多药或广泛耐药引起的颅内感染的有效方案。
