Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Microbiol Spectr. 2022 Jun 29;10(3):e0025322. doi: 10.1128/spectrum.00253-22. Epub 2022 Apr 25.
Carbapenem-resistant Gram-negative bacteria (CRGNB)-related health care-associated ventriculitis and meningitis (HCAVM) is dangerous. We aimed to report the antimicrobial resistance of the pathogens, treatment, and outcome. All cases with CRGNB-related HCAVM in2012-2020 were recruited. Antimicrobial agents were classified as active, untested, or inactive using antimicrobial susceptibility tests. The treatment stage was classified as empirical or targeted according to the report of pathogens. The treatment effect was classified as ineffective or effective according to HCAVM-related parameters. Overall, 92 cases were recruited. For most antimicrobial agents, the resistance rate was higher than 70.0%. The polymyxin resistance rate was the lowest at 11.6%. The chloramphenicol, trimethoprim-sulfamethoxazole, amikacin, levofloxacin, and tetracycline resistance rates were relatively low, ranging from 21.1% to 64.1%. The meropenem resistance rate was 81.9%. There was no significant trend for any antimicrobial agent tested. Meropenem was the most common antimicrobial agent used in empirical treatment; trimethoprim-sulfamethoxazole and polymyxin were the most used active antimicrobial agents, and meropenem/sulbactam and polymyxin were the most used untested antimicrobial agents in targeted treatment. In total, 42 (45.7%) cases received ineffective treatments. The ineffective treatment rate of cases that received active antimicrobial agents was lower than that of cases that received untested antimicrobial agents and cases that received inactive antimicrobial agents (29.3% [12/41] versus 46.2% [18/39] versus 100.0% [12/12], < 0.001). Antimicrobial resistance was prevalent but without increasing trends. Active antimicrobial agents are necessary. Additionally, untested antimicrobial agents, including meropenem/sulbactam and polymyxin, might be optional. Inactive antimicrobial agents must be replaced. Carbapenem-resistant Gram-negative bacteria-related health care-associated ventriculitis and meningitis is a clinical threat because of the poor outcome and challenges in treatment. We reached several conclusions: (i) the antimicrobial resistance of pathogens is severe, and some antimicrobial agents represented by polymyxin are optional according to the antimicrobial susceptibility tests; (ii) in the background that the portion of carbapenems resistance in Gram-negative bacteria is increasing, there is no increasing trend for the antimicrobial resistance of carbapenem-resistant Gram-negative bacteria in the 9-year study; (iii) meropenem is the main antimicrobial agent in treatment, and trimethoprim-sulfamethoxazole, tigecycline, polymyxin, and meropenem/sulbactam are commonly used in the targeted treatment; (iv) the treatment effect was poor and affected by the treatment: timely active antimicrobial agents should be given. And untested antimicrobial agents represented by polymyxin and meropenem/sulbactam might be optional. Inactive antimicrobial agents must be replaced.
耐碳青霉烯类革兰氏阴性菌（CRGNB）相关的医源性脑室炎和脑膜炎（HCAVM）是危险的。我们旨在报告病原体的抗药性、治疗和结果。2012-2020 年期间，我们招募了所有耐碳青霉烯类 CRGNB 相关 HCAVM 的病例。根据抗菌药物敏感性试验，将抗菌药物分为活性、未测试或非活性。根据病原体的报告，将治疗阶段分为经验性或靶向性。根据 HCAVM 相关参数，将治疗效果分为无效或有效。总体而言，共招募了 92 例患者。对于大多数抗菌药物，耐药率高于 70.0%。多粘菌素的耐药率最低，为 11.6%。氯霉素、复方磺胺甲噁唑、阿米卡星、左氧氟沙星和四环素的耐药率相对较低，范围在 21.1%至 64.1%之间。美罗培南的耐药率为 81.9%。没有任何一种被测试的抗菌药物有显著的趋势。美罗培南是经验性治疗中最常用的抗菌药物；复方磺胺甲噁唑和多粘菌素是最常用的活性抗菌药物，而美罗培南/舒巴坦和多粘菌素是靶向治疗中最常用的未测试抗菌药物。总的来说，有 42 例（45.7%）患者接受了无效治疗。接受活性抗菌药物治疗的患者的无效治疗率低于接受未测试抗菌药物和接受非活性抗菌药物治疗的患者（29.3%[12/41]与 46.2%[18/39]与 100.0%[12/12]，<0.001）。抗菌药物耐药性普遍存在，但没有增加的趋势。需要使用活性抗菌药物。此外，未测试的抗菌药物，包括美罗培南/舒巴坦和多粘菌素，可能是可选的。必须更换非活性抗菌药物。耐碳青霉烯类革兰氏阴性菌相关的医源性脑室炎和脑膜炎是一种临床威胁，因为其治疗效果差且治疗具有挑战性。我们得出了以下结论：（i）病原体的抗菌药物耐药性严重，一些抗菌药物（以多粘菌素为代表）根据抗菌药物敏感性试验是可选的；（ii）在革兰氏阴性菌中碳青霉烯类耐药率不断增加的背景下，耐碳青霉烯类革兰氏阴性菌的抗菌药物耐药性在 9 年的研究中没有增加的趋势；（iii）美罗培南是治疗中的主要抗菌药物，复方磺胺甲噁唑、替加环素、多粘菌素和美罗培南/舒巴坦常用于靶向治疗；（iv）治疗效果差，受治疗影响：应及时给予有效的抗菌药物。以多粘菌素和美罗培南/舒巴坦为代表的未测试抗菌药物可能是可选的。非活性抗菌药物必须更换。
