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Lin Z, Chen J, Lin W, Liu B, Weng C, Yang Y, Liu C, Zhang R. Modified ventriculoperitoneal shunt applied to temporary external ventricular drainage. Sci Rep 2024; 14:16009. [PMID: 38992174 PMCID: PMC11239655 DOI: 10.1038/s41598-024-66917-x] [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: 03/21/2024] [Accepted: 07/05/2024] [Indexed: 07/13/2024] Open
Abstract
External ventricular drainage (EVD) is a common procedure in neurosurgical practice. Presently, the three methods used most often include direct EVD (dEVD), long-tunneled external ventricular drains (LTEVDs), and EVD via the Ommaya reservoir (EVDvOR). But they possess drawbacks such as limited duration of retention, vulnerability to iatrogenic secondary infections, and challenges in regulating drainage flow. This study aimed to explore the use of a modified ventriculoperitoneal shunt (mVPS)-the abdominal end of the VPS device was placed externally-as a means of temporary EVD to address the aforementioned limitations. This retrospective cohort study, included 120 cases requiring EVD. dEVD was performed for 31 cases, EVDvOR for 54 cases (including 8 cases with previously performed dEVD), and mVPS for 35 cases (including 6 cases with previously performed EVDvOR). The one-time success rate (no need for further other EVD intervention) for dEVD, EVDvOR, and mVPS were 70.97%, 88.89%, and 91.42%, dEVD vs EVDvOR (P < 0.05), dEVD vs mVPS (P < 0.05), EVDvOR vs mVPS (P > 0.05). Puncture needle displacement or detachment was observed in nearly all cases of EVDvOR, while no such complications have been observed with mVPS. Apart from this complication, the incidence of postoperative complications was 35.48%, 14.81%, and 8.5%, dEVD vs EVDvOR (P < 0.05), dEVD vs mVPS (P < 0.05), EVDvOR vs mVPS (P > 0.05). Mean postoperative retention for EVD was 14.68 ± 9.50 days, 25.96 ± 15.14 days, and 82.43 ± 64.45 days, respectively (P < 0.001). In conclusion, mVPS significantly extends the duration of EVD, which is particularly beneficial for patients requiring long-term EVD.
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Affiliation(s)
- Zhixiong Lin
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Xiangshanyikesong 50#, HaiDian District, Beijing, China.
- Department of Neurosurgery, Fujian Sanbo Funeng Brain Hospital, Fuzhou, Fujian, China.
| | - Jintao Chen
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Xiangshanyikesong 50#, HaiDian District, Beijing, China
- Department of Neurosurgery, Fujian Sanbo Funeng Brain Hospital, Fuzhou, Fujian, China
| | - Weili Lin
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Xiangshanyikesong 50#, HaiDian District, Beijing, China
- Department of Neurosurgery, Fujian Sanbo Funeng Brain Hospital, Fuzhou, Fujian, China
| | - Bei Liu
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Xiangshanyikesong 50#, HaiDian District, Beijing, China
- Department of Neurosurgery, Fujian Sanbo Funeng Brain Hospital, Fuzhou, Fujian, China
| | - Chaoqun Weng
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Xiangshanyikesong 50#, HaiDian District, Beijing, China
- Department of Neurosurgery, Fujian Sanbo Funeng Brain Hospital, Fuzhou, Fujian, China
| | - Yongzhao Yang
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Xiangshanyikesong 50#, HaiDian District, Beijing, China
- Department of Neurosurgery, Fujian Sanbo Funeng Brain Hospital, Fuzhou, Fujian, China
| | - Congai Liu
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Xiangshanyikesong 50#, HaiDian District, Beijing, China
- Department of Neurosurgery, Fujian Sanbo Funeng Brain Hospital, Fuzhou, Fujian, China
| | - Rongbiao Zhang
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Xiangshanyikesong 50#, HaiDian District, Beijing, China
- Department of Neurosurgery, Fujian Sanbo Funeng Brain Hospital, Fuzhou, Fujian, China
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Wang J, Yang Y, Lv W, Xu S, Mei S, Shi F, Shan A. Gentamycin irrigation significantly reduces 28-day surgical site infection after emergency neurosurgery. Br J Neurosurg 2024; 38:481-485. [PMID: 33754915 DOI: 10.1080/02688697.2021.1902472] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 03/03/2021] [Accepted: 03/08/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE This study aims to evaluate the effectiveness of gentamycin irrigation in preventing postoperative surgical site infection (SSI) in emergency neurosurgical procedures. METHODS A total of 518 consecutive emergency neurosurgeries, including craniotomies, endoscopic and burr hole procedures were reviewed retrospectively. Patients received either only normal saline (NS) irrigation or NS irrigation with gentamycin added (80 mg/L) during the whole process of surgery. SSIs including wound infection and intracranial infection were the primary outcome. SSI was considered while purulence was observed during wound dressing and confirmed with bacterial culture of wound exudation. In addition, positive result of bacterial growth culture of cerebrospinal fluid was also considered as infection. Infection rates were calculated 28 days after surgery. Statistical analysis was performed using t test or Chi-squared test where appropriate. RESULTS This study included 444 patients. Gentamycin was used in 179 (40.3%) patients. Only 2 (1.1%) of 179 patients receiving gentamycin irrigation had an infection. However, among the other 265 patients receiving only NS irrigation, the infection rate was 8.3%. With the addition of gentamycin, the infection rate was decreased by 86.7% (P = 0.001). The two infected patients in gentamycin group were compromised postoperatively: one patient had removed his own extraventricular drainage tube accidentally due to restlessness, and the other had severely contaminated his wound with vomitus during the intracranial drainage tube removal process. If these two patients were excluded from analysis, the effective infection rate using gentamycin irrigation is 0%. CONCLUSION The gentamycin plus NS irrigation during emergency neurosurgical procedures can lead to a significantly lower rate of postoperative infection than when NS is used alone.
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Affiliation(s)
- Jin Wang
- Emergency Department, Shenzhen People's Hospital, The Second Medical College of Jinan University, Shenzhen, China
| | - Ying Yang
- Department of Pediatrics, Futian Women and Children Health Institute, Shenzhen, China
| | - Wen Lv
- Emergency Department, Shenzhen People's Hospital, The Second Medical College of Jinan University, Shenzhen, China
| | - Shihai Xu
- Emergency Department, Shenzhen People's Hospital, The Second Medical College of Jinan University, Shenzhen, China
| | - Shanshan Mei
- Emergency Department, Shenzhen People's Hospital, The Second Medical College of Jinan University, Shenzhen, China
| | - Fei Shi
- Emergency Department, Shenzhen People's Hospital, The Second Medical College of Jinan University, Shenzhen, China
| | - Aijun Shan
- Emergency Department, Shenzhen People's Hospital, The Second Medical College of Jinan University, Shenzhen, China
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He G, Lin J, Ye J, Huang F, Yan C, Liu Z, Zhou X, Li Q, Zhang L. Long Tunneled External Ventricular Drains with Shunt Valves: A Technical Note. World Neurosurg 2024; 181:93-95. [PMID: 36220491 DOI: 10.1016/j.wneu.2022.10.010] [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: 07/14/2022] [Revised: 10/03/2022] [Accepted: 10/05/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND External ventricular drain (EVD) is a basic operation in neurosurgery. Due to the limitation of its safe duration, some patients need to receive multiple drainage operations. We describe the long tunneled EVD (LTEVD) with shunt valves that effectively avoid multiple operations as a technical note. METHODS The difference is that the middle part of the drainage tube is connected by an externalized shunt valve. The drainage tube is buried under the skin and the outlet is in the abdomen. The technique and more details are described. RESULTS The connection between the LTEVD and the shunt valve is simple and the required materials are easily accessible. Externalized valves allow the cerebrospinal fluid to be visualized and more controllable, making it easier for physicians to manage the cerebrospinal fluid. No drainage tube failure or secondary infection was observed. The indwelling time of the drainage tube was greatly extended. CONCLUSIONS LTEVD is effective and simple. It allows visual control of drainage flow, prolonging catheter indwelling time and eliminating the need for multiple surgeries.
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Affiliation(s)
- Guilu He
- Department of Neurosurgery, Guangdong 999 Brain Hospital, Guangzhou, China
| | - Jianhao Lin
- Department of Neurosurgery, Guangdong 999 Brain Hospital, Guangzhou, China
| | - Jing Ye
- Department of Neurosurgery, Guangdong 999 Brain Hospital, Guangzhou, China
| | - Fobao Huang
- Department of Neurosurgery, Guangdong 999 Brain Hospital, Guangzhou, China
| | - Changzhi Yan
- Department of Neurosurgery, Guangdong 999 Brain Hospital, Guangzhou, China
| | - Zesi Liu
- Department of Neurosurgery, Guangdong 999 Brain Hospital, Guangzhou, China
| | - Xiuming Zhou
- Department of Neurosurgery, Guangdong 999 Brain Hospital, Guangzhou, China
| | - Qiao Li
- Department of Neurosurgery, Guangdong 999 Brain Hospital, Guangzhou, China
| | - Liang Zhang
- Department of Neurosurgery, Guangdong 999 Brain Hospital, Guangzhou, China.
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Liang Z, Liao W, Chen Q, Li H, Ye M, Zou J, Deng G, Zhang P. Pharmacokinetics of Antituberculosis Drugs in Plasma and Cerebrospinal Fluid in a Patient with Pre-Extensive Drug Resistant Tuberculosis Meningitis. Infect Drug Resist 2023; 16:1669-1676. [PMID: 36992966 PMCID: PMC10041991 DOI: 10.2147/idr.s401281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 03/06/2023] [Indexed: 03/31/2023] Open
Abstract
Drug-resistant tuberculous meningitis (TBM) is the most devastating and critical form of extrapulmonary tuberculosis. Here, we present a case of a 45-year-old male with pre-extensive drug-resistant tuberculosis meningitis (pre-XDR-TBM). He underwent emergency surgery for the long-tunneled external ventricular drainage (LTEVD). Molecular test and phenotypic drug sensitivity test (DST) of Mycobacterium tuberculosis in cerebrospinal fluid (CSF) showed that the isolate was resistant to both rifampin and fluoroquinolones. An anti-tuberculous regimen of isoniazid, pyrazinamide, cycloserine, moxifloxacin, clofazimine, and linezolid was tailored accordingly. We monitored the drug concentration in his plasma and CSF before (at 0-hour) and after anti-TB drugs administration (at 1-hour, 2-hour, 6-hour, and 12-hour) on 10th day after treatment initiation. We hope to provide reference values of drug exposures in plasma and CSF for patients with pre-XDR-TBM.
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Affiliation(s)
- Zhilin Liang
- Department of Pulmonary Medicine & Tuberculosis, The Third People’s Hospital of Shenzhen, National Clinical Research Center for Infectious Disease, Southern University of Science and Technology, Shenzhen, People’s Republic of China
| | - Weiming Liao
- Department of Thoracic Oncology, Jiangxi Provincial Cancer Hospital, Nanchang, People’s Republic of China
| | - Qifu Chen
- Department of Neurosurgery, The Third People’s Hospital of Shenzhen, National Clinical Research Center for Infectious Disease, Southern University of Science and Technology, Shenzhen, People’s Republic of China
| | - Hui Li
- Department of Pulmonary Medicine & Tuberculosis, The Third People’s Hospital of Shenzhen, National Clinical Research Center for Infectious Disease, Southern University of Science and Technology, Shenzhen, People’s Republic of China
| | - Meiling Ye
- Department of Pulmonary Medicine & Tuberculosis, The Third People’s Hospital of Shenzhen, National Clinical Research Center for Infectious Disease, Southern University of Science and Technology, Shenzhen, People’s Republic of China
| | - Jin Zou
- Department of Clinical Laboratory, The Third People’s Hospital of Shenzhen, National Clinical Research Center for Infectious Disease, Southern University of Science and Technology, Shenzhen, People’s Republic of China
| | - Guofang Deng
- Department of Pulmonary Medicine & Tuberculosis, The Third People’s Hospital of Shenzhen, National Clinical Research Center for Infectious Disease, Southern University of Science and Technology, Shenzhen, People’s Republic of China
| | - Peize Zhang
- Department of Pulmonary Medicine & Tuberculosis, The Third People’s Hospital of Shenzhen, National Clinical Research Center for Infectious Disease, Southern University of Science and Technology, Shenzhen, People’s Republic of China
- Correspondence: Peize Zhang; Guofang Deng, Tel +8613509650204; +8613530027001, Email ;
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Liu YF, Huang CL, Tong XM, Zhang Y, Zeng L, Yuan JF. Effect of surgical treatment on prognosis in preterm infants with obstructive hydrocephalus. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2021; 23:1214-1220. [PMID: 34911603 PMCID: PMC8690706 DOI: 10.7499/j.issn.1008-8830.2108119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVES To study the effect of surgical treatment on prognosis in preterm infants with obstructive hydrocephalus. METHODS A retrospective analysis was performed on the medical data of 49 preterm infants with obstructive hydrocephalus. According to the treatment regimen, they were divided into two groups: surgical treatment (n=12) and conservative treatment (n=37). The drainage methods, drainage complications, and eventual shunt outcome were analyzed in the surgical treatment group. The two groups were compared in terms of the etiology of hydrocephalus and prognosis. RESULTS Among the 49 preterm infants with obstructive hydrocephalus, severe intracranial hemorrhage (37 cases; 76%) and central nervous system infection (10 cases, 20%) were the main causes of hydrocephalus. There was no significant difference in the composition of etiology between the two groups (P>0.05). In the surgical treatment group, 4 infants were treated with ventriculosubgaleal shunt and 8 were treated with Ommaya reservoir. One infant had secondary infection and 8 infants eventually underwent ventriculoperitoneal shunt. The surgical treatment group had a significantly higher survival rate than the conservative treatment group (P<0.05). As for the 37 preterm infants with severe intracranial hemorrhage, the surgical treatment group had a significantly higher proportion of infants with normal neurodevelopment than the conservative treatment group (P<0.05). As for the 10 preterm infants with central nervous system infection, neurodevelopmental abnormalities were observed in each of the two groups. CONCLUSIONS Surgical treatment can improve the survival rate of preterm infants with obstructive hydrocephalus and the prognosis of preterm infants with severe intracranial hemorrhage.
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Affiliation(s)
- Yun-Feng Liu
- Department of Pediatrics, Peking University Third Hospital, Beijing 100191, China
| | - Chun-Ling Huang
- Department of Pediatrics, Peking University Third Hospital, Beijing 100191, China
| | - Xiao-Mei Tong
- Department of Pediatrics, Peking University Third Hospital, Beijing 100191, China
| | | | | | - Jin-Fang Yuan
- Department of Pediatrics, Peking University Third Hospital, Beijing 100191, China
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Garg K, Verma SK, Singh PK, Singh M, Chandra PS, Kale SS. Effect of External Ventricular Drain Tunnel Length on Cerebrospinal Fluid Infection Rates-A Bayesian Network Meta-Analysis. World Neurosurg 2021; 158:268-278.e4. [PMID: 34774808 DOI: 10.1016/j.wneu.2021.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 11/01/2021] [Accepted: 11/02/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND External ventricular drain (EVD)-associated cerebrospinal fluid infection (EACI) remains a major complication associated with EVD. Length of EVD tunnel, an overlooked but modifiable factor, can be associated with increased risk of EACI. The aim of this study is to find the tunnel length associated with least chances of EACI by performing a network meta-analysis. METHODS A comprehensive search of different databases was performed to retrieve studies that studied the rates of EACI with different EVD tunnel lengths and a Bayesian network meta-analysis was performed. RESULTS Six studies met the inclusion criteria and were included in the network meta-analysis. With 0 cm tunnel length as reference, the odds ratio (OR) for developing EACI was minimum for tunnel length 5-10 cm (OR, 0.027). It was followed by tunnel length of 5 cm (OR, 0.060) and 10 cm (OR, 0.075). The surface under the cumulative ranking curve plot showed that the probability of the tunnel length 5-10 cm (ranked first), 5 cm (ranked second), and 10 cm (ranked third) for being the best EVD tunnel length was found to be 86%, 64%, and 61%, respectively. CONCLUSIONS The length for which an EVD is tunneled may have an impact on the rate of EACI. Our network meta-analyses showed that the tunnel length of 5-10 cm was associated with the lowest rates of EACI, with 86% probability of being the best EVD tunnel length. The probability of a patient with 5-10 cm EVD length developing EACI was 2.7% compared with zero tunnel length.
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Affiliation(s)
- Kanwaljeet Garg
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India.
| | - Satish Kumar Verma
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Pankaj Kumar Singh
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Manmohan Singh
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - P Sarat Chandra
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Shashank S Kale
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
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Predictor of a permanent shunt after treatment of external ventricular draining in pediatric postinfective hydrocephalus-a retrospective cohort study. Childs Nerv Syst 2021; 37:1877-1882. [PMID: 33483758 DOI: 10.1007/s00381-021-05054-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 01/18/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE To assess the therapeutic efficacy of external ventricular draining (EVD) and to predict the need for permanent shunts in infants with postinfective hydrocephalus (PIHC). METHODS This is a retrospective study of infants diagnosed with PIHC and treated by EVD between January 2013 and December 2017 at the Children's Hospital of Fudan University. Clinical, laboratory, and imaging data were collected and analyzed to identify independent risk factors by logistic regression analyses. The predictor was evaluated using the area under the curve (AUC) of the receiver operating characteristic (ROC) curves. RESULTS In total, 48 patients were identified, and 31 cases (64.5%) had a permanent shunt. EVD was effective in accelerating cerebrospinal fluid purification. In the permanent shunt group, the duration of EVD was significantly longer (28.5 ± 5.2 vs 14.9 ± 3.0 P < 0.05) and the frontal and occipital horn ratio (FOHR) at 7-10 days after EVD was significantly higher (0.57 ± 0.01 vs 0.48 ± 0.01 P < 0.001). The FOHR at 7-10 days after EVD predicts the need for a permanent shunt with an area under the ROC curve of 0.818. CONCLUSION EVD was effective for purification of CSF, whereas a permanent shunt was needed for more than half of the patients. The FOHR at 7-10 days after EVD may be a strong predictor for a permanent shunt.
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Copley PC, Emelifeonwu J, Gallo P, Sokol D, Kandasamy J, Wallace H, Kaliaperumal C. Guideline for the management of long tunnelled external ventricular drains in chronic hydrocephalus. ACTA ACUST UNITED AC 2021; 30:416-421. [PMID: 33830799 DOI: 10.12968/bjon.2021.30.7.416] [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] [Indexed: 11/11/2022]
Abstract
This article reports on the journey of a child with an inoperable hypothalamic-origin pilocytic astrocytoma causing hydrocephalus, which was refractory to treatment with shunts, and required a new approach. With multidisciplinary support, excellent nursing care and parental education, the child's hydrocephalus was managed long term in the community with bilateral long-tunnelled external ventricular drains (LTEVDs). This article describes the patient's journey and highlights the treatment protocols that were created to achieve this feat. Despite the difficulties in initially setting up these protocols, they proved successful and thus the team managing the patient proposed that LTEVDs are a viable treatment option for children with hydrocephalus in the context of inoperable tumours to help maximise quality of life.
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Affiliation(s)
- Phillip Correia Copley
- Neurosurgery Registrar, Department of Paediatric Neurosurgery, Royal Hospital For Sick Children, Edinburgh
| | - John Emelifeonwu
- Neurosurgery Registrar, Department of Paediatric Neurosurgery, Royal Hospital For Sick Children, Edinburgh
| | - Pasquale Gallo
- Neurosurgery Consultant, Department of Paediatric Neurosurgery, Royal Hospital For Sick Children, Edinburgh
| | - Drahoslav Sokol
- Neurosurgery Consultant, Department of Paediatric Neurosurgery, Royal Hospital For Sick Children, Edinburgh
| | - Jothy Kandasamy
- Neurosurgery Consultant, Department of Paediatric Neurosurgery, Royal Hospital For Sick Children, Edinburgh
| | - Hamish Wallace
- Paediatric Oncology Consultant, Department of Paediatric Oncology, Royal Hospital For Sick Children, Edinburgh
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Gupta D, Garg K. Post-Infective Hydrocephalus. Neurol India 2021; 69:S320-S329. [DOI: 10.4103/0028-3886.332273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Chen H, Guo X, Xie D, Dong X, Niu J, Chen G. A Clinical Study on the Use of Intraventricular Polymyxin B Supplemented by Continuous External Ventricular Drainage in the Treatment of Drug-Resistant Gram-Negative Bacilli Intracranial Infection. Infect Drug Resist 2020; 13:2963-2970. [PMID: 32904679 PMCID: PMC7457587 DOI: 10.2147/idr.s261510] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 07/28/2020] [Indexed: 12/20/2022] Open
Abstract
Purpose To investigate the clinical effect of ventricular polymyxin B supplemented by continuous external ventricular drainage in the treatment of intracranial infection with multidrug-resistant (MDR) or extensively drug-resistant (XDR) Gram-negative (G-) bacilli following neurosurgery. Patients and Methods A retrospective analysis was performed on 28 patients who had G-bacilli intracranial infection following neurosurgery in our department between January 2017 and December 2019. The patients were treated with intraventricular polymyxin B supplemented by continuous external ventricular drainage. The clinical characteristics, treatment process, cerebrospinal-fluid-related indicators, results and prognosis were analysed. Results All of 28 patients developed an infection subsequent to neurosurgery, and cerebrospinal fluid (CSF) cultures demonstrated MDR/XDR G- bacilli, including Acinetobacter baumannii in 14 cases, Klebsiella pneumoniae in 9 cases, Pseudomonas aeruginosa in 3 cases, and Enterobacter cloacae in 2 cases. The ventricular drainage tube remained unobstructed in all patients during treatment, and intraventricular polymyxin B combined with intravenous antibiotics were administered each day. The duration of treatment with intraventricular polymyxin B was 14.96±4.28 days, and the time required to obtain a negative CSF culture was 8.23±4.02 days. The bacterial clearance rate from cerebrospinal fluid was 92.9% (26/28), and the clinical cure rate was 82.1% (23/28). Among them, 18 patients underwent ventriculoperitoneal shunt insertion for hydrocephalus 82.5 (59.5,114.75) days after the infection was cured, and the mortality rate was 17.6% (5/28). There was no significant change in patient blood creatinine levels before and after treatment. Cured patients were followed up for 4 months to 3 years, and no recurrences were observed. Conclusion Treatment of intracranial infection with MDR/XDR G- bacilli using early intraventricular polymyxin B supplemented by continuous external ventricular drainage treatment may be a safe and effective treatment strategy.
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Affiliation(s)
- Hongwei Chen
- Department of Neurosurgery for Cerebrospinal Fluid Diseases, Aviation General Hospital of China Medical University, Beijing 100012, People's Republic of China
| | - Xiaochuan Guo
- Department of Neurosurgery for Cerebrospinal Fluid Diseases, Aviation General Hospital of China Medical University, Beijing 100012, People's Republic of China
| | - Dongcheng Xie
- Department of Neurosurgery for Cerebrospinal Fluid Diseases, Aviation General Hospital of China Medical University, Beijing 100012, People's Republic of China
| | - Xuanwei Dong
- Department of Neurosurgery for Cerebrospinal Fluid Diseases, Aviation General Hospital of China Medical University, Beijing 100012, People's Republic of China
| | - Jianxing Niu
- Department of Neurosurgery for Cerebrospinal Fluid Diseases, Aviation General Hospital of China Medical University, Beijing 100012, People's Republic of China
| | - Guoqiang Chen
- Department of Neurosurgery, Aviation General Hospital of China Medical University, Beijing 100012, People's Republic of China
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Jiménez-Mejías ME, Márquez-Rivas FJ. CNS infections in patients with temporary CSF shunts: Diagnostic, preventive and therapeutic approach. Enferm Infecc Microbiol Clin 2020; 38:49-53. [PMID: 31982227 DOI: 10.1016/j.eimc.2020.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 01/07/2020] [Indexed: 10/25/2022]
Affiliation(s)
- Manuel E Jiménez-Mejías
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Infectious Diseases Research Group, Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/University Hospital Virgen del Rocio, Seville, Spain.
| | - Francisco J Márquez-Rivas
- Clinical Unit of Neurosurgery, Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/University Hospital Virgen del Rocio, Center for Advanced Neurology, Seville, Spain
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