Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Middle Wulumuqi Road 12#, Jing'an District, Shanghai, 200040, China.
Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China.
Neurocrit Care. 2024 Apr;40(2):612-620. doi: 10.1007/s12028-023-01781-7. Epub 2023 Jul 27.
Hospital-acquired multidrug-resistant (MDR) bacterial meningitis and/or ventriculitis (MEN) is a severe condition associated with high mortality. The risk factors related to in-hospital mortality of patients with MDR bacterial MEN are unknown. We aimed to examine factors related to in-hospital mortality and evaluate their prognostic value in patients with MDR bacterial MEN treated in the neurointensive care unit.
This was a single-center retrospective cohort study of critically ill neurosurgical patients with MDR bacterial MEN admitted to our hospital between January 2003 and March 2021. Data on demographics, admission variables, treatment, time to start of intraventricular (IVT) therapy, and in-hospital mortality were analyzed. Both univariate and multivariable analyses were performed to identify determinants of in-hospital mortality.
All 142 included patients received systemic antibiotic therapy, and 102 of them received concomitant IVT treatment. The median time to start of IVT treatment was 2 days (interquartile range 1-5 days). The time to start of IVT treatment had an effect on in-hospital mortality (hazard ratio 1.17; 95% confidence interval 1.02-1.34; adjusted p = 0.030). The cutoff time to initiate IVT treatment was identified at 3 days: patients treated within 3 days had a higher cerebrospinal fluid (CSF) sterilization rate (81.5%) and a shorter median time to CSF sterilization (7 days) compared with patients who received delayed IVT treatment (> 3 days) (48.6% and 11.5 days, respectively) and those who received intravenous antibiotics alone (42.5% and 10 days, respectively).
Early IVT antibiotics were associated with superior outcomes in terms of the in-hospital mortality rate, time to CSF sterilization, and CSF sterilization rate compared with delayed IVT antibiotics and intravenous antibiotics alone.
医院获得性多重耐药（MDR）细菌脑膜炎和/或脑室炎（MEN）是一种死亡率高的严重疾病。与 MDR 细菌 MEN 患者住院死亡率相关的危险因素尚不清楚。我们旨在研究与 MDR 细菌 MEN 患者住院死亡率相关的因素，并评估它们在神经重症监护病房接受治疗的患者中的预后价值。
这是一项单中心回顾性队列研究，纳入了 2003 年 1 月至 2021 年 3 月期间我院收治的患有 MDR 细菌 MEN 的危重病神经外科患者。分析了人口统计学、入院变量、治疗、开始脑室（IVT）治疗的时间以及住院死亡率的数据。进行了单变量和多变量分析，以确定住院死亡率的决定因素。
所有 142 例纳入的患者均接受了全身抗生素治疗，其中 102 例患者接受了同时的 IVT 治疗。开始 IVT 治疗的中位时间为 2 天（四分位间距 1-5 天）。开始 IVT 治疗的时间对住院死亡率有影响（风险比 1.17；95%置信区间 1.02-1.34；调整后 p=0.030）。确定开始 IVT 治疗的时间截点为 3 天：在 3 天内接受治疗的患者具有更高的脑脊液（CSF）杀菌率（81.5%）和更短的 CSF 杀菌中位时间（7 天），与接受延迟 IVT 治疗（>3 天）的患者（分别为 48.6%和 11.5 天）和单独接受静脉内抗生素治疗的患者（分别为 42.5%和 10 天）相比。
与延迟 IVT 抗生素和单独静脉内抗生素相比，早期 IVT 抗生素在住院死亡率、CSF 杀菌时间和 CSF 杀菌率方面具有更好的疗效。
