Akıllı Fatih M, Ulukanlıgil Mustafa
Department of Microbiology, Sincan Training and Research Hospital, Ankara, Türkiye.
New Microbiol. 2025 May;48(1):84-88.
Central nervous system infections are recognized as a serious complication in patients, particularly in those with external ventricular drains. Here, we report the case of a 76-year-old woman who presented with nausea, dizziness, and cerebral discomfort following meningioma resection surgery and subsequent external ventricular drain placement. Perioperative ceftriaxone was initiated. During her stay in the intensive care unit, the patient developed a loss of consciousness and respiratory distress, necessitating reoperation for ventricular drain placement. Initial cerebrospinal fluid (CSF) analysis revealed no white blood cells or bacteria, and the first CSF culture showed no growth. However, the patient's respiratory failure and oxygen desaturation progressively worsened. Escherichia coli was detected in deep tracheal aspirate culture, prompting a revision of treatment to piperacillin-tazobactam. Subsequently, Gram-negative coccobacilli were detected in the CSF, which was inoculated into blood culture bottles, yielding a positive signal within three hours. Multiplex PCR analysis using the Biofire BCID-2 sepsis panel identified Acinetobacter baumannii and Klebsiella pneumoniae, both harboring carbapenemase genes (OXA-48 and CTX-M in A. baumannii, KPC in K. pneumoniae). Identification and antibiotic susceptibility testing were performed using Vitek-2 and conventional disc diffusion methods. Urgent intraventricular colistin, in combination with meropenem administered by prolonged infusion, was initiated. This antibiotic regimen successfully eradicated the bacteria from the CSF. Despite microbiological clearance, the patient succumbed to systemic hypotension, worsening oxygen saturation, and uncontrolled complications of diabetes. This case underscores the critical risk of central nervous system infections caused by A. baumannii and K. pneumoniae in patients undergoing neurosurgical procedures, particularly those involving external ventricular drains. Moreover, it highlights the importance of vigilant postoperative monitoring and a multidisciplinary approach in managing complex complications following posterior fossa meningioma surgery.
中枢神经系统感染被认为是患者的一种严重并发症，尤其是在那些使用外部脑室引流管的患者中。在此，我们报告一例76岁女性病例，该患者在脑膜瘤切除手术及随后放置外部脑室引流管后出现恶心、头晕和脑部不适。围手术期开始使用头孢曲松。在她入住重症监护病房期间，患者出现意识丧失和呼吸窘迫，需要再次进行脑室引流管放置手术。最初的脑脊液（CSF）分析显示没有白细胞或细菌，第一次脑脊液培养无生长。然而，患者的呼吸衰竭和氧饱和度逐渐恶化。在深部气管吸出物培养中检测到大肠杆菌，促使将治疗方案改为哌拉西林-他唑巴坦。随后，在脑脊液中检测到革兰氏阴性球杆菌，将其接种到血培养瓶中，三小时内产生阳性信号。使用Biofire BCID-2脓毒症检测板进行的多重PCR分析鉴定出鲍曼不动杆菌和肺炎克雷伯菌，两者均携带碳青霉烯酶基因（鲍曼不动杆菌中的OXA-48和CTX-M，肺炎克雷伯菌中的KPC）。使用Vitek-2和传统纸片扩散法进行鉴定和抗生素敏感性测试。开始紧急脑室内注射黏菌素，并联合延长输注美罗培南。这种抗生素方案成功地从脑脊液中清除了细菌。尽管微生物学清除，但患者死于系统性低血压、氧饱和度恶化和糖尿病的失控并发症。该病例强调了在接受神经外科手术的患者中，尤其是那些涉及外部脑室引流管的患者，由鲍曼不动杆菌和肺炎克雷伯菌引起的中枢神经系统感染的严重风险。此外，它突出了术后密切监测和多学科方法在管理后颅窝脑膜瘤手术后复杂并发症中的重要性。
