Lilley Daniel, Munthali Peter
Department of Microbiology, University Hospitals Coventry & Warwickshire NHS Trust (UHCW), Clifford Bridge Rd, Coventry CV2 2DX, UK.
Infect Prev Pract. 2022 Aug 14;4(4):100240. doi: 10.1016/j.infpip.2022.100240. eCollection 2022 Dec.
Ventriculitis is an infection of the ventricular system of the central nervous system associated with neurosurgery and/or indwelling medical devices mainly caused by coagulase-negative staphylococci and increasingly by Gram-negative bacilli and other Gram-positive bacteria. The Infectious Diseases Society of America (IDSA) and the neurosurgery department University Hospital Coventry and Warwickshire (UHCW) have treatment guidelines for ventriculitis which recommend antimicrobials and device removal.
Data on ventriculitis cases, their management and outcomes were collected from electronic laboratory and hospital records as well as patients' paper records from 2009 to 2019. Cases included patients with CSF shunts or external ventricular drainage. The management of the cases was then compared to both Infectious Diseases Society of America (IDSA) and UHCW guidelines. The data collected included the causative organisms and the use of inappropriate antimicrobials. The cost of inappropriate antimicrobials was calculated.
99 patients with microbiologically confirmed ventriculitis were identified. Some cases had multiple devices and the total number of devices was 105.98% of cases had medical device removal as part of their care. Only 50% and 56% of cases had antimicrobial treatment which was compliant with local (UHCW) and IDSA guidelines, respectively. The most frequently inappropriate antimicrobials used were meropenem and linezolid, at an estimated cost of £201,172 over 10 years. The most frequently isolated organisms were coagulase negative staphylococci. Mortality rate was estimated at 14% of cases.
We report the first analysis of the management of ventriculitis cases at UHCW over a 10-year period and demonstrate the importance of antimicrobial stewardship. We also report the local epidemiology of causes of ventriculitis at UHCW which will guide the empirical treatment of ventriculitis at UHCW.
脑室炎是中枢神经系统脑室系统的一种感染，与神经外科手术和/或留置医疗设备有关，主要由凝固酶阴性葡萄球菌引起，革兰氏阴性杆菌和其他革兰氏阳性细菌引起的情况也日益增多。美国传染病学会（IDSA）以及考文垂和沃里克郡大学医院（UHCW）神经外科制定了脑室炎治疗指南，推荐使用抗菌药物并移除设备。
收集2009年至2019年期间脑室炎病例的数据、治疗情况及结果，数据来源于电子实验室和医院记录以及患者的纸质记录。病例包括脑脊液分流或脑室外引流患者。然后将病例的治疗情况与美国传染病学会（IDSA）和UHCW的指南进行比较。收集的数据包括病原体和不适当抗菌药物的使用情况。计算了不适当抗菌药物的费用。
确定了99例经微生物学确诊的脑室炎患者。部分病例有多个设备，设备总数为105个。98%的病例将移除医疗设备作为治疗的一部分。分别只有50%和56%的病例接受了符合当地（UHCW）和IDSA指南的抗菌治疗。最常使用的不适当抗菌药物是美罗培南和利奈唑胺，预计10年费用为201,172英镑。最常分离出的病原体是凝固酶阴性葡萄球菌。估计死亡率为病例的14%。
我们报告了UHCW在10年期间对脑室炎病例治疗的首次分析，并证明了抗菌药物管理的重要性。我们还报告了UHCW脑室炎病因的当地流行病学情况，这将指导UHCW对脑室炎的经验性治疗。
