Department of Pharmacy, Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou 310009, China.
Department of Pharmacy, Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou 310009, China.
Int J Antimicrob Agents. 2019 Nov;54(5):556-561. doi: 10.1016/j.ijantimicag.2019.08.002. Epub 2019 Aug 6.
This review investigated the effectiveness and safety of intrathecal (ITH) or intraventricular (IVT) antimicrobial therapy for post-neurosurgical intracranial infection due to multidrug-resistant (MDR) and extensively drug-resistant (XDR) Gram-negative bacteria. Electronic databases including PubMed, EMBASE and the Cochrane Library databases were searched for clinical studies that compared the addition of ITH/IVT therapy with intravenous (IV) monotherapy in the treatment of post-neurosurgical intracranial infection due to MDR/XDR Gram-negative bacteria. Eligible articles were analysed using Stata/SE software v.12.0. Publication bias was assessed using Begg's funnel plot and Egger's test. Nine studies involving 296 patients were included. The odds ratio (OR) for death (IV+ITH/IVT versus IV) reported in the included studies ranged from 0.02-0.93. The overall pooled OR was 0.15 [95% confidence interval (CI) 0.08-0.28; P < 0.001] and the risk of mortality was significantly different between the two groups. Microbiological clearance was significantly different between the two groups, with a pooled OR of 0.02 (95% CI 0.01-0.10; P < 0.001). In observational studies, addition of ITH/IVT antimicrobial therapy is associated with a lower risk of mortality and a higher microbiological clearance rate, with mild adverse effects, in patients with post-neurosurgical intracranial infection due to MDR/XDR Gram-negative bacteria. A well-designed randomised controlled trial is necessary to address this important issue.
本综述调查了鞘内（ITH）或脑室内（IVT）抗菌治疗对于多重耐药（MDR）和广泛耐药（XDR）革兰氏阴性菌引起的神经外科术后颅内感染的疗效和安全性。检索了 PubMed、EMBASE 和 Cochrane 图书馆数据库中的电子数据库，以寻找比较 ITH/IVT 治疗与静脉（IV）单药治疗用于治疗 MDR/XDR 革兰氏阴性菌引起的神经外科术后颅内感染的临床研究。使用 Stata/SE 软件 v.12.0 分析合格文章。使用 Begg 漏斗图和 Egger 检验评估发表偏倚。纳入了 9 项涉及 296 名患者的研究。纳入研究报告的死亡率（IV+ITH/IVT 与 IV）的比值比（OR）范围为 0.02-0.93。总体汇总 OR 为 0.15 [95%置信区间（CI）0.08-0.28；P<0.001]，两组间死亡率的风险显著不同。两组间微生物清除率差异显著，汇总 OR 为 0.02（95%CI 0.01-0.10；P<0.001）。在观察性研究中，ITH/IVT 抗菌治疗的加入与 MDR/XDR 革兰氏阴性菌引起的神经外科术后颅内感染患者的死亡率降低和微生物清除率升高相关，且不良反应轻微。需要一项精心设计的随机对照试验来解决这个重要问题。
