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Şahin Y, Sayın E, Aslan Y, Bayri Y. Comparative analysis of linezolid, vancomycin, and hyperbaric oxygen therapies in a rat model of ventriculoperitoneal shunt infection. Childs Nerv Syst 2024; 40:1765-1769. [PMID: 38316673 DOI: 10.1007/s00381-024-06305-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 01/27/2024] [Indexed: 02/07/2024]
Abstract
PURPOSE Staphylococcus epidermidis is the most common causative microorganism of ventriculoperitoneal shunt infections. This study aimed to compare linezolid and vancomycin treatments and to examine the effect of these antibiotics alone and combined with hyperbaric oxygen therapy on the amount of bacterial colonies in the experimental S. epidermidis shunt infection model. METHODS A shunt catheter was placed in the cisterna magna of 49 adult male Wistar albino rats. The rats were randomly divided into seven groups, as follows: sterile control, infected control, vancomycin, linezolid, hyperbaric oxygen, vancomycin + hyperbaric oxygen, linezolid + hyperbaric oxygen. In all groups except the sterile control group, 0.2 ml 107 CFU/mL S. epidermidis was inoculated to the cisterna magna. Parenteral vancomycin was administered 40 mg/kg/day to the vancomycin groups, and 50 mg/kg/day of enteral linezolid to the linezolid groups. Hyperbaric oxygen groups were given 100% oxygen at a pressure of 2.4 ATA for 50 min a day. One day after the last treatment, colony quantities in the shunt catheters and CSF were analyzed. RESULTS The number of CSF colonies in the linezolid group was significantly lower than in the vancomycin group (p < 0.05). The number of CSF colonies in the linezolid + HBO group was significantly lower than in the vancomycin + HBO group (p < 0.05). CONCLUSIONS Linezolid treatment was found to be more effective than vancomycin in ventriculoperitoneal shunt infection caused by S. epidermidis. There was no statistical difference among other treatment groups. Hyperbaric oxygen therapy is shown to contribute to the sterilization of cultures.
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Affiliation(s)
- Yener Şahin
- Department of Neurosurgery, Marmara University School of Medicine, Istanbul, Turkey
| | - Elvan Sayın
- Department of Microbiology, Marmara University School of Medicine, Istanbul, Turkey
| | - Yavuz Aslan
- Department of Diving and Hyperbaric Medicine, TR Health Ministry Health Sciences University Istanbul Sultan Abdülhamit Han Training and Research Hospital, Istanbul, Turkey
| | - Yaşar Bayri
- Department of Neurosurgery, Marmara University School of Medicine, Istanbul, Turkey.
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Bodilsen J, Nielsen H. Early switch to oral antimicrobials in brain abscess: a narrative review. Clin Microbiol Infect 2023; 29:1139-1143. [PMID: 37119987 DOI: 10.1016/j.cmi.2023.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 04/08/2023] [Accepted: 04/24/2023] [Indexed: 05/01/2023]
Abstract
BACKGROUND Early switch to oral antimicrobials has been suggested as a treatment strategy in patients with brain abscess, but the practice is controversial. OBJECTIVES This review aimed to summarize the background, current evidence, and future perspectives for early transition to oral antimicrobials in patients with brain abscess. SOURCES The review was based upon a previous systematic review carried out during the development of the ESCMID guidelines on diagnosis and treatment of brain abscess. The search used 'brain abscess' or 'cerebral abscess' as text or MESH terms in PubMed, EMBASE, and the Cochrane Library. Studies included in the review were required to be published in the English language within the last 25 years and to have a study population of ≥10 patients. Other studies known by the authors were also included. CONTENT In this review, the background for some experts to suggest early transition to oral antimicrobials in patients with mild and uncomplicated brain abscess was clarified. Next, results from observational studies were summarized and limitations discussed. Indirect support for early oral treatment of brain abscess was described with reference to other serious central nervous system infections and general pharmacological considerations. Finally, variations within and between countries in the use of early transition to oral antimicrobials in patients with brain abscess were highlighted. IMPLICATIONS Early transition to oral antimicrobials in patients with uncomplicated brain abscess may be of benefit for patients due to convenience of treatment and potential decreased risks associated with prolonged hospitalization and intravenous lines. The strategy may also confer a more rational allocation of healthcare resources and decrease expenses. However, the benefit/risk ratio for this strategy remains unresolved at present.
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Affiliation(s)
- Jacob Bodilsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; ESCMID Study Group for Infections of the Brain (ESGIB), Basel, Switzerland.
| | - Henrik Nielsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; ESCMID Study Group for Infections of the Brain (ESGIB), Basel, Switzerland
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Kjellberg A, Douglas J, Hassler A, Al-Ezerjawi S, Boström E, Abdel-Halim L, Liwenborg L, Hetting E, Jonasdottir Njåstad AD, Kowalski J, Catrina SB, Rodriguez-Wallberg KA, Lindholm P. COVID-19-Induced Acute Respiratory Distress Syndrome Treated with Hyperbaric Oxygen: Interim Safety Report from a Randomized Clinical Trial (COVID-19-HBO). J Clin Med 2023; 12:4850. [PMID: 37510965 PMCID: PMC10381696 DOI: 10.3390/jcm12144850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 07/16/2023] [Accepted: 07/16/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND A few prospective trials and case series have suggested that hyperbaric oxygen therapy (HBOT) may be efficacious for the treatment of severe COVID-19, but safety is a concern for critically ill patients. We present an interim analysis of the safety of HBOT via a randomized controlled trial (COVID-19-HBO). METHODS A randomized controlled, open-label, clinical trial was conducted in compliance with good clinical practice to explore the safety and efficacy of HBOT for severe COVID-19 in critically ill patients with moderate acute respiratory distress syndrome (ARDS). Between 3 June 2020, and 17 May 2021, 31 patients with severe COVID-19 and moderate-to-severe ARDS, a ratio of arterial oxygen partial pressure to fractional inspired oxygen (PaO2/FiO2) < 26.7 kPa (200 mmHg), and at least two defined risk factors for intensive care unit (ICU) admission and/or mortality were enrolled in the trial and randomized 1:1 to best practice, or HBOT in addition to best practice. The subjects allocated to HBOT received a maximum of five treatments at 2.4 atmospheres absolute (ATA) for 80 min over seven days. The subjects were followed up for 30 days. The safety endpoints were analyzed. RESULTS Adverse events (AEs) were common. Hypoxia was the most common adverse event reported. There was no statistically significant difference between the groups. Numerically, serious adverse events (SAEs) and barotrauma were more frequent in the control group, and the differences between groups were in favor of the HBOT in PaO2/FiO2 (PFI) and the national early warning score (NEWS); statistically, however, the differences were not significant at day 7, and no difference was observed for the total oxygen burden and cumulative pulmonary oxygen toxicity dose (CPTD). CONCLUSION HBOT appears to be safe as an intervention for critically ill patients with moderate-to-severe ARDS induced by COVID-19. CLINICAL TRIAL REGISTRATION NCT04327505 (31 March 2020) and EudraCT 2020-001349-37 (24 April 2020).
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Affiliation(s)
- Anders Kjellberg
- Department of Physiology and Pharmacology, Karolinska Institutet, 171 77 Stockholm, Sweden
- Perioperative Medicine and Intensive Care Medicine, Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Johan Douglas
- Department of Anaesthesia and Intensive Care, Blekingesjukhuset, 371 85 Karlskrona, Sweden
| | - Adrian Hassler
- Department of Physiology and Pharmacology, Karolinska Institutet, 171 77 Stockholm, Sweden
- Acute and Reparative Medicine, Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Sarah Al-Ezerjawi
- Acute and Reparative Medicine, Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Emil Boström
- Acute and Reparative Medicine, Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Lina Abdel-Halim
- Department of Physiology and Pharmacology, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Lovisa Liwenborg
- Department of Physiology and Pharmacology, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Eric Hetting
- Department of Physiology and Pharmacology, Karolinska Institutet, 171 77 Stockholm, Sweden
| | | | | | - Sergiu-Bogdan Catrina
- Department of Molecular Medicine and Surgery, Karolinska Institutet, 171 76 Stockholm, Sweden
- Academic Specialist Center, Center for Diabetes, 113 65 Stockholm, Sweden
| | - Kenny A Rodriguez-Wallberg
- Department of Oncology and Pathology, Karolinska Institutet, 171 64 Stockholm, Sweden
- Department of Reproductive Medicine, Division of Gynaecology and Reproduction, Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Peter Lindholm
- Department of Physiology and Pharmacology, Karolinska Institutet, 171 77 Stockholm, Sweden
- Department of Emergency Medicine, Division of Hyperbaric Medicine, University of California San Diego, La Jolla, CA 92093, USA
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Chau JC, Yan WW, Pang KY. Case report: First case of intracranial abscess treated with Hyperbaric Oxygen Therapy in Hong Kong. SURGICAL PRACTICE 2022. [DOI: 10.1111/1744-1633.12571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Gouveia D, Chichorro M, Cardoso A, Carvalho C, Silva C, Coelho T, Dias I, Ferreira A, Martins Â. Hyperbaric Oxygen Therapy in Systemic Inflammatory Response Syndrome. Vet Sci 2022; 9:vetsci9020033. [PMID: 35202287 PMCID: PMC8880592 DOI: 10.3390/vetsci9020033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 01/01/2022] [Accepted: 01/14/2022] [Indexed: 01/27/2023] Open
Abstract
(1) Background: Systemic inflammatory response syndrome (SIRS) can occur due to a large number of traumatic or non-traumatic diseases. Hyperbaric oxygen therapy (HBOT) may be used as a main or adjuvant treatment for inflammation, leading to the main aim of this study, which was to verify the applicability of HBOT as a safe and tolerable tool in SIRS-positive dogs. (2) Methods: This prospective cohort study included 49 dogs who showed two or more parameters of SIRS, divided into the Traumatic Study Group (n = 32) and the Non-Traumatic Study Group (n = 17). All dogs were submitted to HBOT for 60–90 min sessions, with 2.4–2.8 ATA. (3) Results: This study revealed that 73.5% (36/49) of dogs showed improvement, and the minimum number of HBOT sessions was two, with a mean of 12.73. The number of days between diagnosis and the beginning of HBOT showed statistical significance (p = 0.031) relative to the clinical outcome. No dogs showed any major side effects. (4) Conclusions: We concluded that HBOT may be safe and tolerable for SIRS-positive dogs, and that it should be applied as early as possible.
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Affiliation(s)
- Débora Gouveia
- Arrábida Veterinary Hospital—Lisbon Animal Regenerative and Rehabilitation Center, 2675-655 Odivelas, Portugal; (A.C.); (C.C.); (C.S.); (T.C.); (Â.M.)
- Superior School of Health, Protection and Animal Welfare, Polytechnic Institute of Lusophony, Campo Grande, 1950-396 Lisboa, Portugal
- Correspondence:
| | - Mariana Chichorro
- School of Agrarian and Veterinary Sciences, Department of Veterinary Science, University of Trás-os-Montes and Alto Douro, 5000-801 Vila Real, Portugal; (M.C.); (I.D.)
| | - Ana Cardoso
- Arrábida Veterinary Hospital—Lisbon Animal Regenerative and Rehabilitation Center, 2675-655 Odivelas, Portugal; (A.C.); (C.C.); (C.S.); (T.C.); (Â.M.)
| | - Carla Carvalho
- Arrábida Veterinary Hospital—Lisbon Animal Regenerative and Rehabilitation Center, 2675-655 Odivelas, Portugal; (A.C.); (C.C.); (C.S.); (T.C.); (Â.M.)
| | - Cátia Silva
- Arrábida Veterinary Hospital—Lisbon Animal Regenerative and Rehabilitation Center, 2675-655 Odivelas, Portugal; (A.C.); (C.C.); (C.S.); (T.C.); (Â.M.)
| | - Tiago Coelho
- Arrábida Veterinary Hospital—Lisbon Animal Regenerative and Rehabilitation Center, 2675-655 Odivelas, Portugal; (A.C.); (C.C.); (C.S.); (T.C.); (Â.M.)
| | - Isabel Dias
- School of Agrarian and Veterinary Sciences, Department of Veterinary Science, University of Trás-os-Montes and Alto Douro, 5000-801 Vila Real, Portugal; (M.C.); (I.D.)
| | - António Ferreira
- Faculty of Veterinary Medicine, University of Lisbon, 1300-477 Lisbon, Portugal;
- CIISA—Centro Interdisciplinar-Investigação em Saúde Animal, Faculdade de Medicina Veterinária, Av. Universidade Técnica de Lisboa, 1300-477 Lisbon, Portugal
| | - Ângela Martins
- Arrábida Veterinary Hospital—Lisbon Animal Regenerative and Rehabilitation Center, 2675-655 Odivelas, Portugal; (A.C.); (C.C.); (C.S.); (T.C.); (Â.M.)
- Superior School of Health, Protection and Animal Welfare, Polytechnic Institute of Lusophony, Campo Grande, 1950-396 Lisboa, Portugal
- CIISA—Centro Interdisciplinar-Investigação em Saúde Animal, Faculdade de Medicina Veterinária, Av. Universidade Técnica de Lisboa, 1300-477 Lisbon, Portugal
- Faculty of Veterinary Medicine, Lusófona University, Campo Grande 376, 1749-024 Lisbon, Portugal
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Lichtenberg M, Jakobsen TH, Kühl M, Kolpen M, Jensen PØ, Bjarnsholt T. OUP accepted manuscript. FEMS Microbiol Rev 2022; 46:6574409. [PMID: 35472245 PMCID: PMC9438473 DOI: 10.1093/femsre/fuac018] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 04/04/2022] [Accepted: 04/24/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Mads Lichtenberg
- Costerton Biofilm Center, Department of Immunology and Microbiology, University of Copenhagen, Blegdamsvej 3B, 2200, København, Denmark
| | - Tim Holm Jakobsen
- Costerton Biofilm Center, Department of Immunology and Microbiology, University of Copenhagen, Blegdamsvej 3B, 2200, København, Denmark
| | - Michael Kühl
- Marine Biological Section, Department of Biology, University of Copenhagen, Strandpromenaden 5, 3000 Helsingør, Denmark
| | - Mette Kolpen
- Department of Clinical Microbiology, Copenhagen University Hospital, Ole Maaløes vej 26, 2200, København, Denmark
| | - Peter Østrup Jensen
- Costerton Biofilm Center, Department of Immunology and Microbiology, University of Copenhagen, Blegdamsvej 3B, 2200, København, Denmark
- Department of Clinical Microbiology, Copenhagen University Hospital, Ole Maaløes vej 26, 2200, København, Denmark
| | - Thomas Bjarnsholt
- Corresponding author: Costerton Biofilm Center, Department of Immunology and Microbiology, University of Copenhagen, Blegdamsvej 3B, 2200, København, Denmark. Tel: +45 20659888; E-mail:
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Kjellberg A, Bjerin O, Franzén‐Röhl E, Bartek J, Lindholm P. Lemierre's syndrome caused by Fusobacterium necrophorum complicated with multiple brain abscesses-A case report, literature review, and suggested management. Clin Case Rep 2021; 9:e05142. [PMID: 34917365 PMCID: PMC8643489 DOI: 10.1002/ccr3.5142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/13/2021] [Accepted: 11/15/2021] [Indexed: 11/11/2022] Open
Abstract
We present an unusual case of Lemierre´s syndrome complicated by multiple brain abscesses, a literature review and suggested management. A young man with multiple brain abscesses deteriorated despite two weeks of directed antibiotics. A multidisciplinary approach was successful. Hyperbaric oxygen treatment (HBOT) should be considered in refractory or severe cases.
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Affiliation(s)
- Anders Kjellberg
- Department of Physiology and PharmacologyKarolinska InstitutetStockholmSweden
- Hyperbaric MedicinePerioperative Medicine and Intensive CareKarolinska University HospitalStockholmSweden
| | - Olof Bjerin
- Neuropediatric unitThe Institution for Women´s and Children´s HealthKarolinska InstitutetStockholmSweden
| | - Elisabeth Franzén‐Röhl
- Division of Infectious DiseasesDepartment of Medicine SolnaKarolinska InstitutetStockholmSweden
- Department of Infectious DiseasesKarolinska University HospitalStockholmSweden
| | - Jiri Bartek
- Department of NeurosurgeryKarolinska University HospitalStockholmSweden
- Department of Clinical NeuroscienceKarolinska InstitutetStockholmSweden
- Department of NeurosurgeryRigshospitaletCopenhagenDenmark
| | - Peter Lindholm
- Department of Physiology and PharmacologyKarolinska InstitutetStockholmSweden
- Division of hyperbaric medicineDepartment of Emergency MedicineSchool of MedicineUniversity of California San DiegoLa JollaCaliforniaUSA
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Gottlieb J, Capetian P, Hamsen U, Janssens U, Karagiannidis C, Kluge S, König M, Markewitz A, Nothacker M, Roiter S, Unverzagt S, Veit W, Volk T, Witt C, Wildenauer R, Worth H, Fühner T. [German S3 Guideline - Oxygen Therapy in the Acute Care of Adult Patients]. Pneumologie 2021; 76:159-216. [PMID: 34474487 DOI: 10.1055/a-1554-2625] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Oxygen (O2) is a drug with specific biochemical and physiologic properties, a range of effective doses and may have side effects. In 2015, 14 % of over 55 000 hospital patients in the UK were using oxygen. 42 % of patients received this supplemental oxygen without a valid prescription. Healthcare professionals are frequently uncertain about the relevance of hypoxemia and have low awareness about the risks of hyperoxemia. Numerous randomized controlled trials about targets of oxygen therapy have been published in recent years. A national guideline is urgently needed. METHODS A S3-guideline was developed and published within the Program for National Disease Management Guidelines (AWMF) with participation of 10 medical associations. Literature search was performed until Feb 1st 2021 to answer 10 key questions. The Oxford Centre for Evidence-Based Medicine (CEBM) System ("The Oxford 2011 Levels of Evidence") was used to classify types of studies in terms of validity. Grading of Recommendations, Assessment, Development and Evaluation (GRADE) was used and for assessing the quality of evidence and for grading guideline recommendation and a formal consensus-building process was performed. RESULTS The guideline includes 34 evidence-based recommendations about indications, prescription, monitoring and discontinuation of oxygen therapy in acute care. The main indication for O2 therapy is hypoxemia. In acute care both hypoxemia and hyperoxemia should be avoided. Hyperoxemia also seems to be associated with increased mortality, especially in patients with hypercapnia. The guideline provides recommended target oxygen saturation for acute medicine without differentiating between diagnoses. Target ranges for oxygen saturation are depending on ventilation status risk for hypercapnia. The guideline provides an overview of available oxygen delivery systems and includes recommendations for their selection based on patient safety and comfort. CONCLUSION This is the first national guideline on the use of oxygen in acute care. It addresses healthcare professionals using oxygen in acute out-of-hospital and in-hospital settings. The guideline will be valid for 3 years until June 30, 2024.
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Affiliation(s)
- Jens Gottlieb
- Klinik für Pneumologie, Medizinische Hochschule Hannover.,Biomedical Research in End-stage and Obstructive Lung Disease Hannover (BREATH) im Deutschen Zentrum für Lungenforschung (DZL)
| | - Philipp Capetian
- Klinik für Neurologie, Neurologische Intensivstation, Universitätsklinikum Würzburg
| | - Uwe Hamsen
- Fachbereich für Unfallchirurgie und Orthopädie, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bochum
| | - Uwe Janssens
- Innere Medizin und internistische Intensivmedizin, Sankt Antonius Hospital GmbH, Eschweiler
| | - Christian Karagiannidis
- Abteilung für Pneumologie und Beatmungsmedizin, ARDS/ECMO Zentrum, Lungenklinik Köln-Merheim
| | - Stefan Kluge
- Klinik für Intensivmedizin, Universitätsklinikum Eppendorf, Hamburg
| | - Marco König
- Deutscher Berufsverband Rettungsdienst e. V., Lübeck
| | - Andreas Markewitz
- ehem. Klinik für Herz- und Gefäßchirurgie Bundeswehrzentralkrankenhaus Koblenz
| | - Monika Nothacker
- Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e. V., Marburg
| | | | | | - Wolfgang Veit
- Bundesverband der Organtransplantierten e. V., Marne
| | - Thomas Volk
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum des Saarlandes, Homburg/Saar
| | - Christian Witt
- Seniorprofessor Innere Medizin und Pneumologie, Charité Berlin
| | | | | | - Thomas Fühner
- Krankenhaus Siloah, Klinik für Pneumologie und Beatmungsmedizin, Klinikum Region Hannover.,Biomedical Research in End-stage and Obstructive Lung Disease Hannover (BREATH) im Deutschen Zentrum für Lungenforschung (DZL)
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Ortega MA, Fraile-Martinez O, García-Montero C, Callejón-Peláez E, Sáez MA, Álvarez-Mon MA, García-Honduvilla N, Monserrat J, Álvarez-Mon M, Bujan J, Canals ML. A General Overview on the Hyperbaric Oxygen Therapy: Applications, Mechanisms and Translational Opportunities. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:864. [PMID: 34577787 PMCID: PMC8465921 DOI: 10.3390/medicina57090864] [Citation(s) in RCA: 73] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 08/09/2021] [Accepted: 08/20/2021] [Indexed: 12/17/2022]
Abstract
Hyperbaric oxygen therapy (HBOT) consists of using of pure oxygen at increased pressure (in general, 2-3 atmospheres) leading to augmented oxygen levels in the blood (Hyperoxemia) and tissue (Hyperoxia). The increased pressure and oxygen bioavailability might be related to a plethora of applications, particularly in hypoxic regions, also exerting antimicrobial, immunomodulatory and angiogenic properties, among others. In this review, we will discuss in detail the physiological relevance of oxygen and the therapeutical basis of HBOT, collecting current indications and underlying mechanisms. Furthermore, potential areas of research will also be examined, including inflammatory and systemic maladies, COVID-19 and cancer. Finally, the adverse effects and contraindications associated with this therapy and future directions of research will be considered. Overall, we encourage further research in this field to extend the possible uses of this procedure. The inclusion of HBOT in future clinical research could be an additional support in the clinical management of multiple pathologies.
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Affiliation(s)
- Miguel A. Ortega
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcala de Henares, Spain; (C.G.-M.); (M.A.S.); (M.A.Á.-M.); (N.G.-H.); (J.M.); (M.Á.-M.); (J.B.)
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
- Cancer Registry and Pathology Department, Hospital Universitario Principe de Asturias, 28806 Alcala de Henares, Spain
| | - Oscar Fraile-Martinez
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcala de Henares, Spain; (C.G.-M.); (M.A.S.); (M.A.Á.-M.); (N.G.-H.); (J.M.); (M.Á.-M.); (J.B.)
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
| | - Cielo García-Montero
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcala de Henares, Spain; (C.G.-M.); (M.A.S.); (M.A.Á.-M.); (N.G.-H.); (J.M.); (M.Á.-M.); (J.B.)
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
| | - Enrique Callejón-Peláez
- Underwater and Hyperbaric Medicine Service, Central University Hospital of Defence—UAH Madrid, 28801 Alcala de Henares, Spain;
| | - Miguel A. Sáez
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcala de Henares, Spain; (C.G.-M.); (M.A.S.); (M.A.Á.-M.); (N.G.-H.); (J.M.); (M.Á.-M.); (J.B.)
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
- Pathological Anatomy Service, Central University Hospital of Defence—UAH Madrid, 28801 Alcala de Henares, Spain
| | - Miguel A. Álvarez-Mon
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcala de Henares, Spain; (C.G.-M.); (M.A.S.); (M.A.Á.-M.); (N.G.-H.); (J.M.); (M.Á.-M.); (J.B.)
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
| | - Natalio García-Honduvilla
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcala de Henares, Spain; (C.G.-M.); (M.A.S.); (M.A.Á.-M.); (N.G.-H.); (J.M.); (M.Á.-M.); (J.B.)
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
| | - Jorge Monserrat
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcala de Henares, Spain; (C.G.-M.); (M.A.S.); (M.A.Á.-M.); (N.G.-H.); (J.M.); (M.Á.-M.); (J.B.)
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
| | - Melchor Álvarez-Mon
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcala de Henares, Spain; (C.G.-M.); (M.A.S.); (M.A.Á.-M.); (N.G.-H.); (J.M.); (M.Á.-M.); (J.B.)
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
- Immune System Diseases—Rheumatology, Oncology Service an Internal Medicine, University Hospital Príncipe de Asturias, (CIBEREHD), 28806 Alcala de Henares, Spain
| | - Julia Bujan
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcala de Henares, Spain; (C.G.-M.); (M.A.S.); (M.A.Á.-M.); (N.G.-H.); (J.M.); (M.Á.-M.); (J.B.)
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
| | - María Luisa Canals
- ISM, IMHA Research Chair, Former of IMHA (International Maritime Health Association), 43001 Tarragona, Spain;
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Valente Aguiar P, Carvalho B, Monteiro P, Linhares P, Camacho Ó, Vaz R. Hyperbaric oxygen treatment: Results in seven patients with severe bacterial postoperative central nervous system infections and refractory mucormycosis. Diving Hyperb Med 2021; 51:86-93. [PMID: 33761547 DOI: 10.28920/dhm51.1.86-93] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 11/08/2020] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Resistant bacterial infections following brain and spine surgery and spontaneous mucormycosis with central nervous system (CNS) involvement represent a serious treatment challenge and more efficient therapeutic approaches ought to be considered. Hyperbaric oxygen treatment (HBOT) has shown promise as a complementary therapy. This case series evaluated whether HBOT contributed to infection resolution in seven patients with refractory CNS infectious conditions. METHODS Clinical results for seven patients referred for HBOT between 2010 to 2018 to treat refractory postoperative brain and spine infections or spontaneously developing mucormycosis were retrospectively analysed. The patients' clinical files and follow-up consultations were reviewed to assess evolution and outcome. RESULTS Seven patients were referred with a median age of 56 years. The median follow-up was 20 months. Four patients had postoperative infections and three had rhino-orbital-cerebral mucormycosis (ROCM). HBOT was used as an adjunctive treatment to antimicrobial therapy in all patients. Prior to HBOT, all patients had undergone an average of four operations due to infection refractoriness and had completed an average of five months of antimicrobial therapy. After HBOT, infection resolution was obtained in six patients without additional operations, while one patient with ROCM stopped HBOT after the third session due to intolerance. Three patients stopped antimicrobial therapy while four were maintained on prophylactic treatment. CONCLUSIONS Infection resolution was reached in the six patients that completed HBOT as prescribed. HBOT may serve as an effective complementary treatment in CNS refractory postoperative and spontaneous infections.
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Affiliation(s)
- Pedro Valente Aguiar
- Neurosurgery Department, Centro Hospitalar Universitário São João, Oporto, Portugal.,Faculty of Medicine, Oporto University, Oporto, Portugal.,Corresponding author: Dr Pedro D Valente Aguiar, Department of Neurosurgery, Centro Hospitalar Universitário São João, Alameda Professor Hernâni Monteiro, 4200-319, Porto, Portugal,
| | - Bruno Carvalho
- Neurosurgery Department, Centro Hospitalar Universitário São João, Oporto, Portugal.,Faculty of Medicine, Oporto University, Oporto, Portugal
| | - Pedro Monteiro
- Neurosurgery Department, Centro Hospitalar Universitário São João, Oporto, Portugal.,Faculty of Medicine, Oporto University, Oporto, Portugal
| | - Paulo Linhares
- Neurosurgery Department, Centro Hospitalar Universitário São João, Oporto, Portugal.,Faculty of Medicine, Oporto University, Oporto, Portugal.,Neurosciences Centre, Hospital CUF, Oporto, Portugal
| | - Óscar Camacho
- Hyperbaric Medical Unit, Unidade Local de Saúde de Matosinhos, Portugal
| | - Rui Vaz
- Neurosurgery Department, Centro Hospitalar Universitário São João, Oporto, Portugal.,Faculty of Medicine, Oporto University, Oporto, Portugal.,Neurosciences Centre, Hospital CUF, Oporto, Portugal
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11
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Jensen P, Møller S, Lerche C, Moser C, Bjarnsholt T, Ciofu O, Faurholt-Jepsen D, Høiby N, Kolpen M. Improving antibiotic treatment of bacterial biofilm by hyperbaric oxygen therapy: Not just hot air. Biofilm 2019; 1:100008. [PMID: 33447795 PMCID: PMC7798444 DOI: 10.1016/j.bioflm.2019.100008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 10/22/2019] [Accepted: 10/23/2019] [Indexed: 10/26/2022] Open
Abstract
Bacteria and fungi show substantial increased recalcitrance when growing as infectious biofilms. Chronic infections caused by biofilm growing microorganisms is considered a major problem of modern medicine. New strategies are needed to improve antibiotic treatment of biofilms. We have improved antibiotic treatment of bacterial biofilms by reviving the dormant bacteria and thereby make them susceptible to antibiotics by means of reoxygenation. Here we review the rationale for associating lack of oxygen with low susceptibility in infectious biofilm, and how hyperbaric oxygen therapy may result in reoxygenation leading to enhanced bactericidal activity of antibiotics. We address issues of feasibility and potential adverse effects regarding patient safety and development of resistance. Finally, we propose means for supplying reoxygenation to antibiotic treatment of infectious biofilm with the potential to benefit large groups of patients.
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Affiliation(s)
- P.Ø. Jensen
- Department of Clinical Microbiology, Rigshospitalet, 2100, Copenhagen, Denmark
- Costerton Biofilm Center, Department of Immunology and Microbiology, Faculty of Health Sciences University of Copenhagen, 2200, Copenhagen, Denmark
| | - S.A. Møller
- Department of Clinical Microbiology, Rigshospitalet, 2100, Copenhagen, Denmark
| | - C.J. Lerche
- Department of Clinical Microbiology, Rigshospitalet, 2100, Copenhagen, Denmark
| | - C. Moser
- Department of Clinical Microbiology, Rigshospitalet, 2100, Copenhagen, Denmark
| | - T. Bjarnsholt
- Department of Clinical Microbiology, Rigshospitalet, 2100, Copenhagen, Denmark
- Costerton Biofilm Center, Department of Immunology and Microbiology, Faculty of Health Sciences University of Copenhagen, 2200, Copenhagen, Denmark
| | - O. Ciofu
- Costerton Biofilm Center, Department of Immunology and Microbiology, Faculty of Health Sciences University of Copenhagen, 2200, Copenhagen, Denmark
| | - D. Faurholt-Jepsen
- Copenhagen Cystic Fibrosis Center, Department of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, DK2100, Copenhagen, Denmark
| | - N. Høiby
- Department of Clinical Microbiology, Rigshospitalet, 2100, Copenhagen, Denmark
- Costerton Biofilm Center, Department of Immunology and Microbiology, Faculty of Health Sciences University of Copenhagen, 2200, Copenhagen, Denmark
| | - M. Kolpen
- Department of Clinical Microbiology, Rigshospitalet, 2100, Copenhagen, Denmark
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12
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Udayakumaran S, Joseph T. A proposal for a tailored protocol for focal suppurative infection of the central nervous system: analysis of an institutional experience in pediatric patients. Neurosurg Focus 2019; 47:E11. [DOI: 10.3171/2019.5.focus19277] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 05/09/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThe incidence of focal suppurative infections (FSIs) of the brain has significantly decreased owing to the better health and fundamental conditions of the population on the one hand and earlier detection and the availability of more potent antibiotics on the other. Interestingly, the antibiotic protocols have not been well defined in terms of duration despite a prompter diagnosis, definitive management of the etiology, and the advent of various higher-generation antibiotics. In this study, the authors evaluated the current treatment protocol. Their aim was to optimize management protocols for FSIs of the central nervous system based on clinical parameters.METHODSThe study was a retrospective analysis of all children who had undergone surgical management for an FSI at the Division of Paediatric Neurosurgery, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, in the period from January 2001 to February 2018. In addition to demographic characteristics, the details of culture reports and antibiotic regimens were collected. The response to treatment was compared to changes in the infective profile (C-reactive protein) and imaging. Instances of reaspiration were compared with clinical signs, imaging findings, and infective profiles. Treatment response was separated into two groups: responders within or at 2 weeks and responders beyond 2 weeks. The clinical characteristics of these two groups were compared.RESULTSForty-eight children were treated in the study period. Nineteen patients benefited from the 2-week (short-term) protocol of intravenous antibiotics. Twenty-nine patients required more than 2 weeks (approximately 4 weeks; long-term protocol) for resolution. Of those requiring more than 2 weeks, 69% had cardiogenic etiology. All patients were followed up with a minimum of 3 weeks of oral antibiotics. In a comparative analysis between short-term and long-term responders, only etiology was significantly different. None of the patients who had the short-term protocol had a recurrence.CONCLUSIONSA shorter antibiotic protocol can be used successfully in carefully selected patients who are surgically treated and followed up. It is clear that the 2-week intravenous antibiotic protocol is more suitable for immunocompetent patients who have a noncardiogenic etiology.
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13
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Crabbé A, Jensen PØ, Bjarnsholt T, Coenye T. Antimicrobial Tolerance and Metabolic Adaptations in Microbial Biofilms. Trends Microbiol 2019; 27:850-863. [PMID: 31178124 DOI: 10.1016/j.tim.2019.05.003] [Citation(s) in RCA: 132] [Impact Index Per Article: 26.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 04/25/2019] [Accepted: 05/07/2019] [Indexed: 01/04/2023]
Abstract
Active bacterial metabolism is a prerequisite for optimal activity of many classes of antibiotics. Hence, bacteria have developed strategies to reduce or modulate metabolic pathways to become tolerant. This review describes the tight relationship between metabolism and tolerance in bacterial biofilms, and how physicochemical properties of the microenvironment at the host-pathogen interface (such as oxygen and nutritional content) are key to this relationship. Understanding how metabolic adaptations lead to tolerance brings us to novel approaches to tackle antibiotic-tolerant biofilms. We describe the use of hyperbaric oxygen therapy, metabolism-stimulating metabolites, and alternative strategies to redirect bacterial metabolism towards an antibiotic-susceptible phenotype.
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Affiliation(s)
- Aurélie Crabbé
- Laboratory of Pharmaceutical Microbiology, Ghent University, Ghent, Belgium
| | - Peter Østrup Jensen
- Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark; Department of Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark; Institute for Inflammation Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Thomas Bjarnsholt
- Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark; Department of Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark
| | - Tom Coenye
- Laboratory of Pharmaceutical Microbiology, Ghent University, Ghent, Belgium.
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14
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Bodilsen J, Dalager-Pedersen M, van de Beek D, Brouwer MC, Nielsen H. Incidence and mortality of brain abscess in Denmark: a nationwide population-based study. Clin Microbiol Infect 2019; 26:95-100. [PMID: 31158518 DOI: 10.1016/j.cmi.2019.05.016] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 04/30/2019] [Accepted: 05/19/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To examine the incidence and mortality of brain abscesses. METHODS We accessed nationwide population-based medical registries to obtain data for patients with first-time brain abscesses in Denmark from 1982 through 2016. Annual age- and sex-standardized incidence rates with 95% confidence intervals were calculated and compared by direct standardization. We used Cox regression to compute mortality rate ratios adjusted for age and year groups, sex and Charlson comorbidity index score. RESULTS We identified 1384 patients (37% female). The overall standardized incidence rate of brain abscess was 0.76 per 100 000 person-years (95% confidence interval 0.70-0.81). The incidence rates gradually increased from 0.60 during 1982-88 to 0.90 per 100 000 person-years during 2010-16, yielding an incidence rate ratio of 1.50 (95% confidence interval 1.26-1.79). This increase in incidence was most pronounced in the proportions of brain abscess patients >40 years of age and those with immuno-compromise. The 1-year mortality declined from 29% during 1982-88 to 20% during 2010-16, yielding an adjusted mortality rate ratio of 0.44 (95% confidence interval 0.31-0.63). Risk factors for death were advanced age, Charlson comorbidity index >0, immuno-compromised status and congenital heart disease. CONCLUSIONS The incidence of brain abscess in Denmark is low but increasing, especially in the elderly, along with an increasing proportion of brain abscess patients with immuno-compromise. The prognosis has improved during the last decades, but mortality remains high. Risk factors for death in our study were advanced age, presence of comorbidity, immuno-compromised status and congenital heart disease.
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Affiliation(s)
- J Bodilsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark.
| | - M Dalager-Pedersen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
| | - D van de Beek
- Department of Neurology, Amsterdam UMC, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - M C Brouwer
- Department of Neurology, Amsterdam UMC, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - H Nielsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
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15
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Hyperbaric oxygen therapy: Antimicrobial mechanisms and clinical application for infections. Biomed Pharmacother 2018; 109:440-447. [PMID: 30399579 DOI: 10.1016/j.biopha.2018.10.142] [Citation(s) in RCA: 99] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 10/19/2018] [Accepted: 10/24/2018] [Indexed: 11/24/2022] Open
Abstract
Hyperbaric oxygen therapy (HBOT) is a treatment procedure that involves breathing 100% O2 for a certain time and under a certain pressure. HBOT is commonly administrated as a primary or alternative therapy for different diseases such as infections. In this paper, we reviewed the general aspect of HBOT procedures, the mechanisms of antimicrobial effects and the application in the treatment of infections. Parts of the antimicrobial effects of HBOT are believed to result of reactive from the formation of reactive oxygen species (ROS). It is also said that HBOT enhances the antimicrobial effects of the immune system and has an additive or synergistic effect with certain antimicrobial agents. HBOT has been described as a useful procedure for different infections, particularly in deep and chronic infections such as necrotizing fasciitis, osteomyelitis, chronic soft tissue infections, and infective endocarditis. The anti-inflammation property of HBOT has demonstrated that it may play a significant role in decreasing tissue damage and infection expansion. Patients treated by HBOT need carful pre-examination and monitoring. If safety standards are strictly tracked, HBOT can be considered a suitable procedure with an apt rate of complication.
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16
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Lange N, Berndt M, Jörger AK, Wagner A, Wantia N, Lummel N, Ryang YM, Meyer B, Gempt J. Clinical characteristics and course of primary brain abscess. Acta Neurochir (Wien) 2018; 160:2055-2062. [PMID: 30069602 DOI: 10.1007/s00701-018-3633-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 07/19/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Due to improved diagnostic methods, the incidence of brain abscess is still rising. Therefore, clear and evidence-based therapy for the patients who suffer from brain abscesses is necessary. Brain abscesses are potentially life-threatening conditions that possibly lead to permanent injuries even after sufficient healing has taken place. The aims of this study were to analyze the clinical aspects of patients with brain abscesses and thereby to reveal the relevant aspects for the future treatment of the brain lesions. METHODS We retrospectively identified 47 patients (24 male, 23 female) who had received surgery or undergone the frameless stereotactic drainage of brain abscesses in our center from March 2009 to May 2017. We analyzed the clinical characteristics of the patients, as well as comorbidities and outcomes. RESULTS The mean age was 58 (range 7 to 86). Focus identification was successful in 28 patients (60%), with the most frequent causes of brain abscesses including the following: sinusitis (25%), dental infections (25%), and mastoiditis (21%). The mean Charlson Comorbidity Index was 1.57. Among the patients, 34% showed immunosuppressive conditions. We performed 1.5 surgeries per patient (53% via craniotomy, 28% biopsies or stereotactic drainage, 19% both procedures), followed by antibiotic treatment for 6.5 weeks (mean). In 30% of patients, no bacteria could be isolated. During the follow-up period (a median of 12 months), 23.4% of the patients died. The mortality rate during the initial hospital stay was 4.3%. CONCLUSION One third of the patients with brain abscesses showed immunosuppressive conditions, whereas brain abscesses also often occur in patients with good medical conditions. The isolation of the focus of infection is often possible. Surgical procedures showed very good outcomes. Patients over 60 years showed significantly worse clinical outcomes.
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Affiliation(s)
- Nicole Lange
- Neurosurgical Department, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
- Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Maria Berndt
- Neuroradiological Department, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Ann-Kathrin Jörger
- Neurosurgical Department, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Arthur Wagner
- Neurosurgical Department, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Nina Wantia
- Microbiological Department, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Nina Lummel
- Neuroradiological Department, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Yu-Mi Ryang
- Neurosurgical Department, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Bernhard Meyer
- Neurosurgical Department, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Jens Gempt
- Neurosurgical Department, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
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17
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Hyperbaric Oxygen Therapy and Utilization in Infectious Disease. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2018. [DOI: 10.1007/s40138-018-0166-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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18
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Bartek Jr. J, Skyrman S, Nekludov M, Mathiesen T, Lind F, Schechtmann G. Hyperbaric Oxygen Therapy as Adjuvant Treatment for Hardware-Related Infections in Neuromodulation. Stereotact Funct Neurosurg 2018; 96:100-107. [DOI: 10.1159/000486684] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 01/08/2018] [Indexed: 11/19/2022]
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