Department of Pharmacy, The Johns Hopkins Hospital, and Anesthesiology & Critical Care Medicine, Johns Hopkins University School of Medicine, Carnegie 180, Baltimore, MD, 21287, USA.
UK Healthcare, University of Kentucky, Lexington, USA.
Neurocrit Care. 2019 Jun;30(3):609-616. doi: 10.1007/s12028-018-0647-0.
Central nervous system (CNS) infections are particularly prevalent in the adult neurocritical care patient population and are associated with significant morbidity and mortality. Factors relevant to the nature of CNS infections pose significant challenges to clinicians treating afflicted patients. Intraventricular (IVT) administration of antibiotics may offer several benefits over systemic therapy; however, the outcomes and current practices of such treatments are poorly described in the literature.
To describe current practices and outcomes of patients receiving intraventricular antibiotic treatment for CNS infections in neurological intensive care units of academic medical centers nationwide.
A retrospective cohort study was conducted on patients admitted to intensive care units who received IVT antibiotic treatment at participating centers in the USA between January 01, 2003, and December 31, 2013. Clinical and laboratory parameters, microbiology, surgical and antimicrobial management, and treatment outcomes were collected and described.
Of the 105 patients included, all received systemic antimicrobial therapy along with at least one dose of IVT antimicrobial agents. Intraventricular vancomycin was used in 52.4% of patients. The average dose was 12.2 mg/day for a median duration of 5 days. Intraventricular aminoglycosides were used in 47.5% of the patients, either alone or in combination with IVT vancomycin. The average dose of gentamicin/tobramycin was 6.7 mg/day with a median duration of 6 days. Overall mortality was 18.1%. Cerebrospinal fluid (CSF) culture sterilization occurred in 88.4% of the patients with a rate of recurrence or persistence of positive cultures of 9.5%.
Intraventricular antimicrobial agents resulted in a high CSF sterilization rate. Contemporary use of this route typically results in a treatment duration of less than a week. Prospective studies are needed to establish the optimal patient population, as well as the efficacy and safety of this route of administration.
中枢神经系统（CNS）感染在成人神经重症监护患者中尤为普遍，与显著的发病率和死亡率相关。与 CNS 感染性质相关的因素给治疗此类患者的临床医生带来了巨大挑战。与全身治疗相比，脑室内（IVT）给予抗生素可能具有多种益处；然而，此类治疗的结果和当前实践在文献中描述甚少。
描述全国学术医学中心神经重症监护病房 CNS 感染患者接受脑室内抗生素治疗的当前实践和结果。
对 2003 年 1 月 1 日至 2013 年 12 月 31 日期间在参与研究的美国中心住院并接受 IVT 抗生素治疗的患者进行回顾性队列研究。收集并描述了临床和实验室参数、微生物学、手术和抗菌管理以及治疗结果。
在纳入的 105 例患者中，所有患者均接受了全身抗菌治疗，并且至少接受了一剂 IVT 抗菌药物。52.4%的患者使用了脑室内万古霉素。平均剂量为 12.2mg/天，中位持续时间为 5 天。47.5%的患者使用了脑室内氨基糖苷类药物，单独使用或与脑室内万古霉素联合使用。庆大霉素/妥布霉素的平均剂量为 6.7mg/天，中位持续时间为 6 天。总死亡率为 18.1%。88.4%的患者脑脊液（CSF）培养得到了灭菌，阳性培养物复发或持续存在的比率为 9.5%。
脑室内抗生素治疗导致 CSF 灭菌率很高。目前这种治疗方法的使用通常持续不到一周。需要前瞻性研究来确定最佳患者人群以及这种给药途径的疗效和安全性。
