Neurosurgery Department, Military Hospital "Dr Alejandro Dávila Bolaños", Managua, Nicaragua.
Quality Department, Military Hospital "Dr Alejandro Dávila Bolaños", Managua, Nicaragua.
Childs Nerv Syst. 2024 Apr;40(4):1019-1030. doi: 10.1007/s00381-023-06240-4. Epub 2023 Nov 28.
We aimed to determine the safety and effectiveness of intraventricular antibiotics in neonates with meningitis and/or ventriculitis and analyze the quality of available evidence.
DESIGN: Systematic review and meta-analysis.
PubMed, EMBASE, LILACS, and SCOPUS up to 17 February 2023.
Randomized experimental and observational studies were included. The Cochrane methodology was used for systematic reviews.
Twenty-six observational studies and one randomized clinical trial involving 272 patients were included. The risk of bias in both pediatric and neurosurgical studies was high, and the quality of evidence was low (evidence level C). In the pediatric studies, no significant differences in mortality were found between intraventricular antibiotics and only systemic antibiotic [25.4% vs 16.1%, OR = 0.96 (0.42-2.24), P = 0.93]. However, when analyzing the minimum administered doses, we found a lower mortality when a minimum duration of 3 days for intraventricular antibiotics was used compared to only systemic antibiotic [4.3% vs 17%, OR = 0.22 (0.07-0.72), P = 0.01]. In the neurosurgical studies, the use of intraventricular antibiotics in ventriculitis generally results in a mortality of 5% and a morbidity of 25%, which is lower than that in cases where intraventricular antibiotics were not used, with an average mortality of 37.3% and a morbidity of 50%.
Considering the low quality of evidence in pediatric and neurosurgical studies, we can conclude with a low level of certainty that intraventricular antibiotics may not significantly impact mortality in neonatal meningitis and ventriculitis. However, reduced mortality was observed in cases treated with a minimum duration of 3 days of intraventricular antibiotic, particularly the multidrug-resistant or treatment-refractory infections. Higher-quality studies are needed to improve the quality of evidence and certainty regarding the use of intraventricular antibiotics for treating neonatal meningitis and ventriculitis.
本研究旨在评估脑室抗生素在患有脑膜炎和/或脑室炎的新生儿中的安全性和有效性，并分析现有证据的质量。
设计：系统评价和荟萃分析。
PubMed、EMBASE、LILACS 和 SCOPUS 数据库，检索时间截至 2023 年 2 月 17 日。
包括随机对照试验和观察性研究。系统评价采用 Cochrane 方法。
共纳入 26 项观察性研究和 1 项随机临床试验，涉及 272 例患者。儿科和神经外科研究的偏倚风险均较高，证据质量较低（证据水平 C）。在儿科研究中，脑室抗生素和单纯全身抗生素治疗的死亡率无显著差异[25.4%比 16.1%，OR=0.96（0.42-2.24），P=0.93]。然而，当分析最低给药剂量时，我们发现与单纯全身抗生素相比，使用脑室抗生素的最短疗程为 3 天时死亡率较低[4.3%比 17%，OR=0.22（0.07-0.72），P=0.01]。在神经外科研究中，脑室炎患者使用脑室抗生素的死亡率一般为 5%，发病率为 25%，低于未使用脑室抗生素的患者，死亡率平均为 37.3%，发病率为 50%。
鉴于儿科和神经外科研究的证据质量较低，我们可以得出较低确定性的结论，即脑室抗生素可能不会显著影响新生儿脑膜炎和脑室炎的死亡率。然而，我们观察到使用最短 3 天疗程的脑室抗生素治疗的患者死亡率降低，特别是对多重耐药或治疗抵抗的感染。需要更高质量的研究来提高脑室抗生素治疗新生儿脑膜炎和脑室炎的证据质量和确定性。
