Gavrilovska Aleksandra Dimovska, Veljanovski Hristijan, Jovchevski Radomir
University Clinic of Neurosurgery, Clinical Center "Mother Theresa", 1000 Skopje, Republic of North Macedonia.
Institute of Microbiology and Parasitology, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, 50 Divizija 6, 1000 Skopje, Republic of North Macedonia.
J Surg Case Rep. 2024 Sep 23;2024(9):rjae603. doi: 10.1093/jscr/rjae603. eCollection 2024 Sep.
Healthcare-associated central nervous system infections are a significant complication for patients undergoing neurosurgical interventions. We present a case of a 6-year-old patient with an embryonal tumor of the central nervous system. Following a craniotomy for the resection of the tumor, an external ventricular drainage was placed. Several weeks after surgery, she developed signs of meningism. Cerebrospinal fluid cultures were positive for pan-drug resistant . Several revisions with the insertion of new external valves were done. She was treated with intravenously meropenem and vancomycin combined with colistin administrated intraventricularly. Significant improvement was seen clinically with negative cultures after 2 weeks. The synergistic action of colistin administrated locally combined with systemic antibiotics may be a promising option for critically ill patients with pan-drug resistant central nervous system infection.
医疗保健相关的中枢神经系统感染是接受神经外科手术的患者的一种严重并发症。我们报告一例6岁患有中枢神经系统胚胎性肿瘤的患者。在进行肿瘤切除的开颅手术后，放置了外部脑室引流管。术后几周，她出现了脑膜刺激征的症状。脑脊液培养显示对全耐药菌呈阳性。进行了几次更换新的外部瓣膜的手术。她接受了静脉注射美罗培南和万古霉素，并联合脑室内注射黏菌素治疗。2周后临床症状显著改善，培养结果为阴性。局部使用黏菌素与全身抗生素联合的协同作用可能是治疗全耐药中枢神经系统感染重症患者的一个有前景的选择。
