Li Muyun, Meng Wei, An Linna, Lin Xiaoqi, Yang Shangjie, Fu Qiang, Shi Qiuxia, Li Dongfeng, Wang Jie, Wang Jianhua, Wang Yubo
State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Xinjiang Medical University, Urumqi, Xinjiang Uygur Autonomous Region, China.
Pharmacy School, Xinjiang Medical University, South Shangde Road, Urumqi, Xinjiang Uygur Autonomous Region, China.
BMC Infect Dis. 2025 May 2;25(1):644. doi: 10.1186/s12879-025-11031-0.
Although clinical guidelines recommend vancomycin-based combination therapy for patients with postoperative intracranial infections in neurosurgery, the trend of global bacterial resistance and the management of antimicrobial agents have made monotherapy a common treatment option for some patients. This study aims to compare the efficacy of single-drug therapy (SDT) versus vancomycin combination therapy (VCT) in treating central nervous system infections (CNSIs) following neurosurgery.
A retrospective cohort study was conducted, adjusting for various covariates such as length of stay (LoS), admission status, age, comorbidity status (Charlson Comorbidity Index, CCI), surgical and incision levels, and duration of surgery (DOS) using propensity score matching (PSM) with a 1:2 ratio. The treatment effects of the two empirical treatment regimens were evaluated through PSM and logistic regression for dual robustness.
A total of 539 patients met the inclusion criteria, with 177 cases in SDT and 101 cases in VCT after PSM. The clinical cure rate was 76% in the SDT compared to 90% in the VCT (p = 0.007) after PSM. Of the result of antibiotic susceptibility testing, only 13.9% of cases identified specific pathogens, of which gram-positive cocci were the dominant. VCT was significantly more effective than SDT, both in unadjusted (OR 2.941, 95% CI 1.434-6.607, p = 0.005) and adjusted models (OR 3.605, 95% CI 1.611-8.812, p = 0.003). Gender, race, and surgical complexity were significant factors influencing treatment choice; female patients and those with complex surgeries were less likely to receive SDT. Although SDT was practically effective for treating CNSIs, VCT proved superior for complex infections.
The findings of this study suggest that, given concerns about antibiotic resistance and the varying complexities of infections, while SDT is effective in certain cases, VCT remains the preferred choice for complex CNSIs. This research provides important references for clinical practice, highlighting the need to consider multiple factors when selecting treatment options and advancing the understanding of treatment strategies for postoperative central nervous system infections.
尽管临床指南推荐对神经外科术后颅内感染患者采用以万古霉素为基础的联合治疗，但全球细菌耐药趋势及抗菌药物管理使得单药治疗成为部分患者的常用治疗选择。本研究旨在比较单药治疗（SDT）与万古霉素联合治疗（VCT）在治疗神经外科术后中枢神经系统感染（CNSIs）方面的疗效。
进行一项回顾性队列研究，采用倾向评分匹配（PSM），以1:2的比例对各种协变量进行调整，如住院时间（LoS）、入院状态、年龄、合并症状态（Charlson合并症指数，CCI）、手术及切口级别和手术时长（DOS）。通过PSM和逻辑回归评估两种经验性治疗方案的治疗效果，以实现双重稳健性。
共有539例患者符合纳入标准，PSM后SDT组有177例，VCT组有101例。PSM后，SDT组的临床治愈率为76%，而VCT组为90%（p = 0.007）。在抗生素敏感性测试结果中，仅13.9%的病例鉴定出特定病原体，其中革兰氏阳性球菌占主导。VCT比SDT显著更有效，在未调整模型（OR 2.941，95% CI 1.434 - 6.607，p = 0.005）和调整模型（OR 3.605，95% CI 1.611 - 8.812，p = 0.003）中均如此。性别、种族和手术复杂性是影响治疗选择的重要因素；女性患者和手术复杂的患者接受SDT的可能性较小。尽管SDT在治疗CNSIs方面实际有效，但VCT在治疗复杂感染方面被证明更具优势。
本研究结果表明，考虑到对抗生素耐药性的担忧以及感染的不同复杂性，虽然SDT在某些情况下有效，但VCT仍然是复杂CNSIs的首选治疗方法。本研究为临床实践提供了重要参考，强调在选择治疗方案时需要考虑多个因素，并增进了对术后中枢神经系统感染治疗策略的理解。
