延长序贯静脉和口服抗菌治疗可提高颅内神经外科手术后感染的治愈率：一项西班牙多中心回顾性研究。
Extended sequential intravenous and oral antimicrobial therapy improves cure rate in postoperative intracranial neurosurgical infections: a Spanish multicenter retrospective study.
机构信息
Infectious Diseases-HIV Unit, Hospital Universitario Central de Asturias, Avenida de Roma s/n, Oviedo, 33011, Spain.
Microbiology and Infectious Diseases Group, FINBA-ISPA, Oviedo, Spain.
出版信息
BMC Infect Dis. 2024 Nov 26;24(1):1345. doi: 10.1186/s12879-024-10204-7.
BACKGROUND
Postoperative intracranial neurosurgical infections (PINI) complicate < 5% neurosurgeries. Scarce attention was dedicated to the extension and characteristics of its antimicrobial management considering their high morbidity, not negligible mortality, delayed hospital stay and increased healthcare costs.
METHODS
We analyzed retrospectively (2014-2023) 162 PINI from eight Spanish third-level academic hospitals.
RESULTS
Elective clean craniotomies after tumor or vascular causes were the leading procedures. Epidural abscess (24.7%), scalp infections (19.8%), postsurgical meningitis (16.7%) and cranioplasty infections (16.7%) were the most frequent PINI. Gram negative bacteria (38.6%) and Staphylococcus spp (28.6%) were the predominant isolates. Overall 85.2% patients underwent pus drainage, mostly by craniotomy (40.3%). Interestingly 34% were already receiving antibiotics for extracranial infections before developing PINI while 16.8% did not receive pre-operative antibiotic prophylaxis. In total 77.2% patients started a combined intravenous (IV) antimicrobial therapy, of which 85.2% switched after 5 days to a second-line IV antibiotic regimen, in 41.3% cases combined, after pus culture results, for a median of 21 days. Overall 61.1% patients continued on oral antimicrobials after hospital discharge, 30.3% as a combined regimen, for a median of 42 days. Complete cure was obtained in 81.5% cases, while 11.1% relapsed, 7.4% failed to cure and 6.8% died after PINI complications. In the multivariate analysis oral antimicrobial therapy after hospital discharge (p = 0.001) was significantly associated with PINI cure with no effect on survival.
CONCLUSIONS
We conclude that an extended 6 weeks sequential IV and oral antimicrobial therapy in addition to neurosurgical correction increases PINI cure rate with no effect on survival.
CLINICAL TRIAL NUMBER
Not applicable.
背景
术后颅内神经外科感染（PINI）在<5%的神经外科手术中较为常见。由于其发病率高、死亡率不可忽视、住院时间延长和医疗费用增加，针对其抗菌管理的扩展和特点，关注度一直较低。
方法
我们回顾性分析了来自西班牙 8 家三级学术医院的 162 例 PINI。
结果
肿瘤或血管原因所致的择期清洁性开颅术是主要手术。硬膜外脓肿（24.7%）、头皮感染（19.8%）、术后脑膜炎（16.7%）和颅骨成形术感染（16.7%）是最常见的 PINI。革兰氏阴性菌（38.6%）和葡萄球菌属（28.6%）是主要分离株。85.2%的患者接受了脓肿引流，主要通过开颅术（40.3%）。有趣的是，34%的患者在发生 PINI 之前已经在接受针对颅外感染的抗生素治疗，而 16.8%的患者没有接受术前抗生素预防。共有 77.2%的患者开始接受静脉（IV）联合抗菌治疗，其中 85.2%在 5 天后根据脓液培养结果切换至二线 IV 抗生素方案，41.3%为联合方案，疗程中位数为 21 天。出院后，共有 61.1%的患者继续接受口服抗菌药物治疗，30.3%为联合方案，疗程中位数为 42 天。81.5%的患者获得完全治愈，11.1%的患者复发，7.4%的患者治疗失败，6.8%的患者因 PINI 并发症死亡。多变量分析表明，出院后口服抗菌药物治疗（p=0.001）与 PINI 治愈显著相关，对生存率无影响。
结论
我们得出结论，在神经外科矫正的基础上，延长 6 周的序贯 IV 和口服抗菌治疗可提高 PINI 的治愈率，对生存率无影响。
临床试验编号
不适用。
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