Rahim Md Abdur, Biswas Himel Kumar, Zilani Md Abdul Kader, Biswas Rama, Ershad Sirazul Haque
Department of Neuro-ICU Square Hospitals Ltd. Dhaka Bangladesh.
Department of Neurology Square Hospitals Ltd. Dhaka Bangladesh.
Clin Case Rep. 2024 Nov 15;12(11):e9559. doi: 10.1002/ccr3.9559. eCollection 2024 Nov.
Multiple drug resistance to infection treatment is a great challenge for neuro-intensivists due to poor drug penetration through the blood-brain barrier (BBB). Fortunately, the intraventricular administration of polymyxin-B and tigecycline seems to be effective; there are few case reports demonstrating the effectiveness of such treatments. Here, we report the case of a 24-year-old male who presented with fever and neck rigidity after intracranial drainage following lung infection caused by MDR . Due to the presence of turbid CSF, the administration of the intrathecal (ITH) route polymyxin-B and tigecycline is not possible. In this situation, the neuro-intensivist decided to start intraventricular tigecycline and polymyxin-B administration along with IV tigecycline and polymyxin-B via the intraventricular route, which was feasible because the patient had an external ventricular drain (EVD) due to obstructive hydrocephalus caused by the neurosurgeon after excision of the tumor.
由于药物透过血脑屏障（BBB）的能力较差，多重耐药感染的治疗对神经重症监护医生来说是一项巨大挑战。幸运的是，脑室内给予多粘菌素B和替加环素似乎有效；仅有少数病例报告证明了此类治疗的有效性。在此，我们报告一例24岁男性病例，该患者因耐多药菌引起肺部感染，在颅内引流术后出现发热和颈部强直。由于脑脊液浑浊，无法通过鞘内（ITH）途径给予多粘菌素B和替加环素。在这种情况下，神经重症监护医生决定开始通过脑室内途径给予脑室内替加环素和多粘菌素B，同时静脉给予替加环素和多粘菌素B，这是可行的，因为患者因神经外科医生在肿瘤切除后造成的梗阻性脑积水而留置了外部脑室引流管（EVD）。
