Combined Strategy for Post-Operative Patients with Central Nervous System Infections Caused by Extensively Drug-Resistant/Pan-Drug-Resistant : A Retrospective Study.

Post-operative central nervous system infections (PCNSIs) caused by extensively drug-resistant (XDR) or pan-drug-resistant (PDR) are rare but intractable problems. To investigate a potential combined strategy to treat organisms that are resistant to not only meropenem but also colistin. We retrospectively reviewed cerebrospinal fluid positive culture isolates of in patients who underwent neurosurgery. Medical records were collected by standard forms and analyzed. Sixteen patients met the criteria and most patients were middle-aged males who had undergone craniotomy or endonasal trans-sphenoidal surgery. A total of 68.8% isolates were XDR bacteria, and 18.8% of isolates were PDR bacteria. Twelve patients were treated by meropenem-based regimen strategy. Another four patients were administered tetracycline-based regimens. A total of 93.8% patients were treated with therapeutic drainage and strict hygiene rules were followed. Finally, 12 patients survived their infections, and the average Glasgow Outcome Scale score was 2.9 ± 1.4 at discharge. The mortality rates of carbapenem-resistant (CRAB) were 8.3%. Post-operative central nervous system infections caused by XDR/PDR are a rare and serious complication. Combined therapy based on the individual situation, including appropriate antimicrobial agents, surgical management, and strict hygiene management might be an effective therapeutic strategy.