Chen FuMei, Deng Xianyu, Wang Zhanpeng, Wang Li, Wang Ke, Gao Liang
Department of Neurosurgery, Shanghai Tenth People's Hospital, Tongji University, Shanghai 200072, China,
Department of Emergency Surgery, The First Affiliated Hospital of Medical School of Zhejiang University, Hangzhou 360001, China.
Infect Drug Resist. 2019 Jan 21;12:241-247. doi: 10.2147/IDR.S186646. eCollection 2019.
Severe ventriculitis (SV) caused by multidrug-resistant bacteria is associated with high morbidity and mortality in neurosurgical patients. This study assessed the outcomes of patients with SV caused by who were treated by intraventricular (IVT) lavage and colistin administration.
This retrospective study included consecutive patients with SV caused by who were admitted at the Neurosurgical Department of Shanghai Tenth People's Hospital from January 2014 to September 2017. Patients' medical records, radiographic images, and surgical notes were reviewed. The patients were followed up for at least 6 months after discharge.
A total of 25 patients, including 20 male and five female, were enrolled in this study; the average age was 45.6 years. All patients underwent neurosurgery before infection, and all cultures from cerebrospinal fluid (CSF) showed extensive resistance to the tested antibiotics except for tigecycline and colistin. All the patients underwent IVT lavage followed by daily administration of colistin after surgery; 24 patients received a daily colistin dose of 100,000 IU, while one received 50,000 IU. The patients also received tigecycline-based systemic antibiotic treatment. The mean duration of IVT colistin was 13.4±2.8 days. The time required to obtain a negative CSF culture was 8.9±4.0 days. Of the 20 patients who were cured, eight underwent shunt surgery due to hydrocephalus before they were discharged to a rehabilitation center. Five patients died, including one who was re-admitted due to recurrence 1 month after discharge.
IVT lavage and colistin treatment may be an effective treatment for SV caused by extensively drug-resistant . Future studies with a larger sample size may be needed to verify the findings in this study.
耐多药细菌引起的严重脑室炎（SV）在神经外科患者中与高发病率和死亡率相关。本研究评估了因[具体细菌名称未给出]导致的SV患者经脑室内（IVT）灌洗和使用黏菌素治疗的结果。
这项回顾性研究纳入了2014年1月至2017年9月在上海第十人民医院神经外科收治的因[具体细菌名称未给出]导致的SV连续患者。对患者的病历、影像学图像和手术记录进行了回顾。患者出院后至少随访6个月。
本研究共纳入25例患者，其中男性20例，女性5例；平均年龄为45.6岁。所有患者在感染前均接受了神经外科手术，脑脊液（CSF）的所有[具体细菌名称未给出]培养结果显示，除替加环素和黏菌素外，对所测试的抗生素均具有广泛耐药性。所有患者均接受了IVT灌洗，术后每日使用黏菌素；24例患者每日黏菌素剂量为100,000 IU，1例患者剂量为50,000 IU。患者还接受了基于替加环素的全身抗生素治疗。IVT黏菌素的平均使用时间为13.4±2.8天。获得脑脊液培养阴性结果所需时间为8.9±4.0天。在20例治愈患者中，8例在出院前往康复中心之前因脑积水接受了分流手术。5例患者死亡，其中1例在出院后1个月因复发再次入院。
IVT灌洗和黏菌素治疗可能是治疗由广泛耐药[具体细菌名称未给出]引起的SV的有效方法。可能需要进一步开展更大样本量的研究来验证本研究结果。
