Department of Infectious Diseases and Clinical Microbiology, Health Sciences University, Antalya Training and Research Hospital, Antalya, Turkey.
Surg Infect (Larchmt). 2021 Dec;22(10):1059-1063. doi: 10.1089/sur.2021.024. Epub 2021 Aug 5.
Post-operative nosocomial meningitis is a critical complication that develops in patients after neurosurgical interventions and operations. Data were collected for 65 patients who were diagnosed as having nosocomial meningitis after neurosurgery. The agent profile, clinical and biochemical differences in gram-negative and gram-positive meningitis, and the effectiveness of intrathecal antibiotic administration in cases with carbapenem-resistant gram-negative agents were evaluated. Gram-negative bacteria were isolated in 52.3% of patients. In gram-negative cases of post-operative nosocomial meningitis, white blood cell count (p = 0.015), C-reactive protein (p = 0.001), cerebrospinal fluid leukocyte count (p = 0.0001), and protein (p = 0.0001) were higher, and glucose (p = 0.002) was lower. Concurrent bacteremia (p = 0.041), 14-day mortality (p = 0.022), and 30-day mortality (p = 0.023) were higher in gram-negative cases. Empirical treatment was appropriate in 78.5% of the patients. Seventeen patients (26.2%) received intrathecal antibiotic agents in addition to intravenous antibiotic treatment because of carbapenem-resistant gram-negative bacteria. Nine (53%) of the patients receiving intrathecal therapy had as the agent, six had (35.4%), one had (5.8%), and one had (5.8%). The mean intravenous treatment duration was 21.4 ± 10.6 (4-60) days, and the mean intrathecal treatment duration was 17.6 ± 14.0 (1-51) days. Eleven patients received colistimethate sodium intrathecally (1 × 10 mg/d), three patients received amikacin intrathecally (1 × 10 mg/d), and three patients received gentamicin intrathecally (1 × 10 mg/d). Clinical and microbiologic treatment success was achieved in nine patients (53%). In cases of meningitis caused by carbapenem-resistant agents, intrathecal administration of antibiotic agents such as gentamicin, amikacin, and colistin with limited blood-brain barrier transition in intravenous administration will increase survival. Therefore, intrathecal antibiotic administration should be considered as a part of routine of nosocomial meningitis.
术后医院获得性脑膜炎是神经外科干预和手术后患者发生的一种严重并发症。我们收集了 65 名被诊断为神经外科手术后医院获得性脑膜炎的患者的数据。评估了革兰氏阴性和革兰氏阳性脑膜炎的病原体谱、临床和生化差异，以及对碳青霉烯类耐药革兰氏阴性菌患者鞘内给予抗生素的效果。52.3%的患者分离出革兰氏阴性菌。在革兰氏阴性术后医院获得性脑膜炎病例中，白细胞计数（p=0.015）、C 反应蛋白（p=0.001）、脑脊液白细胞计数（p=0.0001）和蛋白（p=0.0001）较高，而葡萄糖（p=0.002）较低。同时发生菌血症（p=0.041）、14 天死亡率（p=0.022）和 30 天死亡率（p=0.023）在革兰氏阴性病例中较高。经验性治疗在 78.5%的患者中是合适的。由于碳青霉烯类耐药革兰氏阴性菌，17 名患者（26.2%）除了静脉抗生素治疗外还接受了鞘内抗生素治疗。接受鞘内治疗的 17 名患者中有 9 名（53%）使用了多粘菌素 B，6 名使用了阿米卡星（35.4%），1 名使用了庆大霉素（5.8%），1 名使用了头孢他啶（5.8%）。静脉治疗的平均持续时间为 21.4±10.6（4-60）天，鞘内治疗的平均持续时间为 17.6±14.0（1-51）天。11 名患者鞘内给予多粘菌素乙（1×10mg/d），3 名患者鞘内给予阿米卡星（1×10mg/d），3 名患者鞘内给予庆大霉素（1×10mg/d）。9 名患者（53%）获得临床和微生物学治疗成功。对于碳青霉烯类耐药菌引起的脑膜炎，静脉内给予限制血脑屏障转运的抗生素，如庆大霉素、阿米卡星和多粘菌素 B，增加了生存率。因此，鞘内抗生素给药应被视为医院获得性脑膜炎常规治疗的一部分。
